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Reversing the Cardiac Effects of Sedentary Ageing in the Middle Age – A Randomised Controlled Trial

Source: Circulation.

Authors: Erin J Howden, Satyam Sarma, Justin S Lawley, Mildred Opondo, William Cornwell, Douglas Stoller, Marcus A Urey, Beverley Adams-Huet, Benjamin D Levine.

Commentary: Dr Natalie Ward, Senior Research Fellow & Prof Chris Reid, John Curtin Distinguished Professor; Curtin University. 

Ageing and sedentary behavior are major risk factors for cardiovascular disease, with poor fitness in middle age a strong predictor of heart failure. This is likely due to an increase in left ventricular stiffness, a consequence of sedentary ageing. Reversing the effects of cardiac ageing may protect against the development of heart failure, however it’s unclear whether exercise training can restore or improve cardiac function and if so, when is the appropriate age to intervene. Epidemiological studies have suggested the beneficial effects of exercise are most commonly observed in middle-age (45-64 years), possibly due to middle-aged hearts retaining some degree of plasticity. A recent randomized controlled trial published in Circulation has demonstrated that regular (> 4 days/week), long-term (2 years) high-intensity exercise, initiated in middle-age improved cardiac function in healthy, sedentary individuals compared to a balance and flexibility (yoga) control group.

The high-intensity exercise included an individualized training program with training frequency, duration and intensity increasing over time. An initial training phase of 1-2 months established an endurance base and regular routine, with additional aerobic and recovery sessions added over 3-5 months. By 6 months, exercise intensity was 5-6 hours per week which was maintained for another 4 months. At 10 months, participants entered the maintenance phase, again individually tailored to their current exercise capacity. To maintain retention, the control group was prescribed a combination of yoga, balance and strength training 3 times per week, with instruction to avoid hot yoga or prolonged endurance activities. Both groups regularly met with exercise physiologists, maintained exercise logs and underwent heart rate monitoring.

Overall the study found that 2 years of high-intensity exercise training improved maximal oxygen uptake and decreased cardiac stiffness in previously sedentary healthy middle-aged men and women. Although small in numbers (53 participants completed the study), this is the longest, prospective randomized controlled trial to assess the physiological effects of supervised, structured high-intensity exercise on cardiac function. While the study does provide important mechanistic insight into the beneficial effects of such an exercise program, there are several limitations to consider. Perhaps the most important of these is the exercise program offered to the participants, which involved individually tailored programs, regular meetings and mentorship from an exercise physiologist and ongoing encouragement and incentive to remain in the program. Unfortunately, in the real world, while most people are well aware of the health benefits of exercise, such a training program is not only beyond their means, but also difficult to implement. In addition to understanding the mechanisms behind the benefits of exercise, future research on implementing and maintaining exercise programs in large population groups should also be considered.

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