Physical Activity: Better Late Than Never, But Better Early Than Late

New studies suggest that moderate to vigorous exercise may delay heart disease in elderly adults between 70-75.  

The most common cause of heart disease is the narrowing or blockage of the coronary arteries. Another known cause of heart disease is problems with the valves in the heart, or the heart may not pump well enough, causing heart failure. It is known that exercising can help reduce your risk of heart disease; however, physical activity in the elderly is not well studied. A better understanding of whether exercise in the elderly can still promote healthy aging is essential in preventing significant heart disease in this population. 

The study was pulled from Progetto Veneto Anziani-Pro V.A. A cohort study evaluated 2,754 Italians who were 65 years or older (mean age 75.1±7 years). Each participant had a baseline assessment in 1995-1997, and follow-up visits 4 and 7 years. Extended surveillance to 2018 was performed through hospital discharge records and death certificates. More than 1,000 new diagnoses of heart disease, heart failure, and stroke were made during this time. This study reviewed whether the persistence of an active lifestyle over time, participation in physical activity, and increasing or decreasing physical activity levels were associated with a reduced risk of heart disease and overall mortality.   

This study showed that the incidence rates of cardiovascular events were lower in both active groups of men and women. It also showed lower mortality risks in both active groups. There was also observed a lower incidence of coronary artery disease and heart failure in the active group. The risk reduction of any incident of a cardiovascular event associated with an active lifestyle in men and at least 20 minutes of physical activity per day was most marked at 70 years, while it was only moderately reduced at 75 years, and no signs of correlation were observed at 80 and 85. The study reveals that the persistence of active life in older people may improve prognosis; however, including physical activity early in life is more beneficial than the introduction later in life. The mechanism of physical activity action in slowing down cardiovascular disease is not fully understood. It is thought to slow down the atherosclerosis process by better controlling blood pressure, blood glucose, and lipid profile.  

Increased physical activity with an active lifestyle was associated with a decreased risk of heart disease and death in both men and women. Older and active participants achieved the most significant benefits at 70. Data from the study showed that 20 to 40 minutes of daily physical activity has the most significant decrease in heart disease and heart failure. Relying on participants to go to follow-up visits at the appropriate time can be seen as a limitation to this study. In addition, the assessment of activity levels is subjective. The study also lacks knowledge of participants’ fitness levels earlier in their lives, as this can significantly prevent significant heart disease. Nevertheless, the study concluded that the results suggest that promoting or beginning a physical activity in mid and early late-life can play a significant role in reducing cardiovascular risks. This data should encourage health care providers to make early assessments of their patient’s physical activity and motivate a passive patient to initiate and maintain moderate physical activity early in life to benefit from the reduced cardiovascular risk reduction.  

Practice Pearls:  

• The best way to delay significant heart disease in elderly adults between 70 and 75 may be moderate to vigorous exercise. 
• 2,754 Italians aged 65 years or older from 1995 to 1997 were scanned. 
• Patients’ physical activity was determined through a questionnaire during each evaluation period – physical activity exceeding 20 minutes was defined as active. 

Fabris E, Sinagra G. Physical activity in older people: better late than never, but better early than late. Heart. 2022;108(5):328-329. doi:10.1136/heartjnl-2021-320462 

Emily Walser, PharmD Candidate 2022, Lake Erie College of Osteopathic Medicine, College of Pharmacy