The document discusses the effects of aging on the cardio-pulmonary system. Key effects include increased heart weight and stiffness of blood vessels and the heart, reduced elasticity of the lungs, decreased maximum oxygen uptake, and reduced respiratory muscle strength. Exercise can help counter some of these effects by increasing cardiac output and lung capacity in older adults, though benefits are less for those who are very old, sedentary, or have medical issues.

1. Effect of aging in
CARDIO-PULMONARY SYSTEM
Krishna priya

2. ?
PHYSIOTHERAPY - AGING

3.  Physiological changes
 Exercise prescription
 Exercise response
 Factors affecting aging – biological and psychological
factors, disuse, disease etc…….
SAFETY OF THE CLIENT DURING REHABILITATION

4. ANATOMICAL -
 Increase in heart weight
 Decrease in myocardial cells and enlargement of
remaining cells
Cardio-vascular system

5.  Increased left ventricular thickness
 Increase in left atrial size
 Reduced elastin and increased collagen in the intimal
layer of the heart and blood vessel walls and
calcification stiffness
 Decreased aortic distensibility

6.  Stiffness increase in systolic blood pressure
 Decreased distensibility increased load on LV
AT REST
Diastolic properties
EDV in cardiac cycle -
 Sufficient venous return
 Relaxation of ventricles
 Duration of atrial contraction
 Inspite of the stiffness if the walls, LA increase in size
maintains EDV
Relation between anatomical and
physiological changes

7.  Increase in iso-volumic myocardial relaxation
 Decrease in ventricular filling rate in early diastole
 Over all increased diastole of ventricles
DURING ACTIVITY OR MINIMAL EXERCISE
 EDV index increases
 Ventricular filling rate decreases due to prolonged
relaxation time and ventricular stiffness

8. AT REST
Systolic properties
 End systolic volume
 Stroke volume same
 Ejection fraction
DURING ACTIVITY OR MINIMAL EXERCISE
 End systolic volume
 Ejection fraction
 Myo-cardial contractility

9. Causes –
 Decreased response to B-adrenergics
 Systolic BP
 Ventricular wall changes
AEROBIC CAPACITY
 VO2 max
 As age VO2 max
 0.4-0.5 ml/kg/min/yr – male
 0.2-0.35 ml/kg/min/yr – female
 10% per decade

10.  VO2 max inversely proportional to body weight and
physical inactivity
Causes –
 Maximum HR
 CO and SV
 A-V O2 difference
OTHER CHANGES
 Reduced baro receptor and cardio pulmonary reflexes
 Reduced A-V dilatation
 Postural hypotension

11. Diastole –
 Left ventricular wall thickness
 Left ventricular filling rate
 End diastolic volume
Systole –
 Myocardial contractility
 End diastolic volume
 Ejection fraction
Effect of aging

12.  Arterial wall thickness
 Systolic blood pressure
 Diastolic blood pressure
 Orthostatic tolerance
 Arterial and venous dilation
 Vasoconstriction
same

13.  Cause peripheral effects not central
 HR max cannot be changed so SV, CO, VO2 max cannot
be altered significantly
 Extraction of O2 by peripheral skeletal musculature
 A-V O2 difference
VO2 max increases
 EDV at rest and exercise
 Peak rate of ventricular filling
Effect of exercise training on CVS

14.  6 months – avg- 30 min, 3 times/week, 4-6 months –
increased VO2 max by 14%
 Active / sedentary – VO2 max reduces
(5%) (10%)
Poor improvements in
 Less initial VO2 max
 Increased age
 Short sessions of exercises
 Short over all duration of the study period

15. Study –
60-82 yrs, intensive endurance training,
Increase in EDV and peak ventricular filling rates
Causes
 Increased uptake of Ca
 Reduced relaxation time
 Increased fatty acid oxidation and cytochrome C
oxidase levels

16. Systolic performance
 Increased exercise stroke volume,
 Increased ejection fraction, on exercise
 End systolic volume decrease
Very old age, estrogen deficient women – no changes
on exercise training

17.  Improvement in postural hypotension – blood flow to
peripherally active muscles from inactive limbs and
viscera
 Reduce systolic and diastolic BP
 Reduce age related baro-reflex sensitivity
 Alters ANS and its control on resting HR
 Increase para-sympathetic activity and attenuates
sympathetic activity

18. Long term aerobic training -
 Decrease symp + at given work rate
 Decrease exe HR
 Decrease BP

19. Diastole – on exercise
 Left ventricular wall thickness
 Left ventricular filling rate
 End diastolic volume
Systole –
 Myocardial contractility
 End diastolic volume
 Ejection fraction
Effect of exercise training

20.  Arterial wall thickness ?
 Systolic blood pressure
 Diastolic blood pressure /
 Orthostatic tolerance ?
 Arterial and venous dilation ?
 Vasoconstriction
 Central venous pressure ?

21. PULMONARY SYSTEM

22. Anatomical changes – (thoracic cage, lungs, diaphragm)
decreased –
 Calcification of costal cartilage with sternum
 Degenerative changes in thoracic spine and rib
articulations
 Kyphosis
 Reduced intervertebral spaces, Wedge shaped
 Increases AP diameter
 Resp muscles in mechanically disadvantageous position
 Decreased force generation

23.  Loss of elastic fibres in alveolar ducts
 Loss and destruction of supporting structures of lung
parenchyma
 Pre-mature closure of airways
Hyper-inflation
 Elastic recoil
 chest wall compliance
 Progressive decrease in respiratory muscle strength
(mild)

24.  Compliance – lung and chest wall
 Decrease in chest wall complian
-ce is more than lung compliance

25. Decrease in
 Alveolar – capillary surface area
 Alveolar surface area
 Total surface area of lung parenchyma
 Pulmonary blood flow volume
 Reduced diffusion
 Increased dead space ventilation
 V/Q mis-match

27.  Reduced elastic recoil – reduced exp flow + narrowing
of airways
Reduced FEV1
 Reduced closing volumes, increased FRC and RV
Reduced FVC and flow rates
 Increased FRC TV decreases

29.  Minute ventilation –RR*vol of air inhaled in 1 breath
 Increase in RR, inspite of TV inspiration
 Diaphragm – change in muscle type – reduced type 1
muscle fibres
Easy fatigue during increased load on RS
Increased WOB

30. Immunological changes –
 BAL – broncho alveolar lavage
 Increased neutrophils; IgA, IgM,
 Reduced macrophages
 Antigens toxin production
Increased T lymphocytes
Increased neutrophils
Release of super-oxide

31. Persistent low grade inflammation
Damage to lung matrix
Impaired gaseous exchange
 ELF- epithelial lining fluid – rich in anti-oxidants
Aging – reduced ELF
Increased susceptibility to env toxins

32. 25-35/40 yrs (plateau)
Growth and maturation declines
0-20 yrs
Pulmonary changes also depend on -
nutrition / diet
life style – sedentary/active, smoking
infections, environment
immune system

33.  Chest wall stiffness
 Elastic recoil
 Alveolar capillary surface area
 Forced expiratory flow
 Total residual volume
 Forced vital capacity
 P I max and P E max
 V/Q matching
 Pa O2
 Oxygen saturation
 Pulmonary vascular resistance
Effect of aging

34.  Expiratory flow limitation
 Minute ventilation
 Work of breathing
 Resp muscle O2 consumption
 Pulmonary artery pressure

35. DURING ACTIVITY OR MINIMAL EXERCISE
 Expiratory flow limitation due to narrow air ways
 Increase in minute volume, minimal increase in TV,
more in RR, shortness of breath
 Increased WOB to meet O2 demands via alveolar
ventilation, diffusion
 Exe – stiff alveolar walls – reduced elastic recoil-
increase pressure development by insp and exp
muscles – increased WOB – increased O2 consumption
by resp muscles (10-12% of total body O2 consumption)

36. Sub-maximal exe – aerobic training – MV
 Walking, 70 yr, 12 week sub-maximal aerobic exe, 7.7%
in MV
 Reduced breathlessness
 Low exertion
 Use of low % of max ventilatory capacity during
exercise (reduced WOB)
Effect of exercise training

37. Maximal exercise – 5 days/ week, 78% HR max
 Same case 14% in max MV
 Improved MV in terms of TV not RR

38. aging on exercise
 Expiratory flow limitation
 Minute ventilation S M
 Work of breathing
 Resp muscle O2 consumption
 Arterial hypoxemia
 Pulmonary artery pressure
 Pulmonary wedge pressure
Effect of exercise training

39. Thank You