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AHA: Physical activity benefits older adults’ heart health
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The improvement of physical function can benefit older adults with heart disease through increasing the quality of life and providing more independence, according to a scientific statement from the American Heart Association.
“Whereas most major randomized controlled trials of therapies for CVD are usually oriented to outcomes metrics of mortality, morbidity (clinical events) and hospitalizations, they rarely address the associated risks of functional loss that can occur even if the initial therapies seem to go well,” Daniel E. Forman, MD, FAHA, professor of medicine at the University of Pittsburgh Medical Center and VA Pittsburgh Healthcare System, and colleagues wrote. “Not only are strategies to better preserve physical capacity and to minimize declines important steps to reduce disease-related mortality and morbidity, but many older patients regard preserved function, independence and related self-efficacy as their primary goals of care; that is, for many patients, conserved functional capabilities become more important than traditional disease-specific therapeutic endpoints.”
Forman and colleagues analyzed the current body of research to provide information and make recommendations on the importance of physical function for older adults.
Benefits of activity
With an increasing population of older adults, measures of physical function and the benefits of exercise are becoming increasingly important in clinical studies, according to the researchers.
In recent trials, endurance exercise has been found to improve cardiorespiratory function in previously sedentary healthy older adults, with up to a 25% increase in peak oxygen uptake. Studies have also found that strength training and aerobic exercise can have beneficial effects on older adults. In one study, strength training for institutionalized elderly individuals aged at least 80 years doubled their strength in several weeks and reduced their dependence on wheelchairs and walkers.
“The functional declines that occur with aging are magnified by the development of CVD,” the researchers wrote. “Therefore, CVD is likely to occur in older adults who are already functionally impaired, with greater potential to compound functional limitations to the point when [activities of daily life] and independence are threatened.”
Therefore, by focusing on physical function as a therapeutic priority, older adults with or at risk for CVD can have improved outcomes.
Initiating physical activity
In older adults, who may have been living a sedentary lifestyle for an extended period of time, initiating physical activity may be difficult, according to the researchers.
Cardiac rehabilitation is one solution for health care providers to suggest to increase physical activity for their patients. In addition, cardiac rehabilitation has been shown to achieve a 20% to 31% reduction in mortality from CAD.
Despite the benefits, only 13% to 34% of eligible adults use cardiac rehab, with older adults being even less likely to attend.
“Given the low use of outpatient phase 2 [cardiac rehab] by older individuals, there is growing interest in new [cardiac rehab] approaches,” the researchers wrote. “Transitional and home-based phase 2 [cardiac rehab] models have been shown to be effective and safe, although they are not standardized and often not reimbursed by insurance.”
Mobile technologies may also provide solutions for initiating cardiac rehab and physical activity in this population.
Although exercise training has proven benefits in older populations, the researchers suggest that encouragement from health care providers to complete simple daily activities, such as making the bed and climbing the stairs, may be beneficial. Balance, strength and mobility are important measurements of physical function in the elderly.
Measuring physical function
scientific statement details methods for health care providers to assess functional capabilities of their patients.
Physical function can be measured by peak oxygen uptake, strength, balance and flexibility. It can also be influenced by cognition, inflammation and mitochondrial metabolism.
“Physical function is an important indicator of prognostic risk and a key influence on the daily life of older adults with CVD,” the researchers wrote. “In particular, inability to perform [activities of daily life] reduces quality of life, but even the progressive loss of strength and [cardiorespiratory function] can translate into reduced confidence and mood. Although the importance of physical function is well defined in published literature, the use of this important outcome measure for establishing the efficacy of a particular intervention among older adults should be considered in the context of regulatory stringency, in relation to other components of patient-reported outcomes, and in respect to the impact that non-CVDs may also have on this measure.”
Importance of physical function
Because functional impairment compounds CVD and older individuals constitute a larger portion of the CVD population, therapeutic interventions that target physical function are important, according to the researchers.
Attending rehabilitation programs and initiating appropriate exercise plans are some of the options available to the older population to improve their physical function.
“There is a need for better recognition by clinicians of the importance of physical function in older adults,” the researchers wrote. “Current standards of medications and disease management have glaring deficiencies in attention to function and prioritization of interventions to enhance and maintain exercise capacity.” – by Cassie Homer
Disclosure: The researchers report no relevant financial disclosures.
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