Cardiovascular Health and The Over-65's

As sure as it is that time will pass, the physiological changes associated with ageing will inevitably affect us all. Whilst we cannot change the nature of ageing, and its effects, we might be able to slow down the ageing process, thus improving quality of life and reducing the risk of associated illnesses and injuries.

How can we achieve this? Lifestyle and dietary interventions have shown promising results, but only one intervention has consistently demonstrated the ability to attenuate functional decline amongst older adults: physical exercise (1).

Many physiological changes are associated with ageing. These changes cannot be avoided, but through regular exercise, the onset can be delayed and the effects minimised. Some of the effects which impact, and can be improved by, exercise include:

• Sarcopenia - the progressive loss of skeletal muscle and strength. After age 30, the rate of muscle loss is approximately 3-5% per decade (2) (3).

• Reduced cardiac output - the amount of blood pumped by the heart. The cardiac output of an 80-year-old is about half that of a 20-year-old (4).

• Reduced lung volume - vital lung capacity reduces by 22-26ml per year after age 20 (5).

• Joint degradation - loss of elasticity in tendons, shortening of ligaments and a reduction of synovial fluids can lead to joint degradation and pain (6).

• Neurological decline - reduced cognitive function and altered memory recall (7).

These changes have an array of implications in terms of health and fitness. On one hand, the changes mean that exercise becomes harder and exercise performance is decreased. This could lead to a decrease in motivation and, ultimately, discontinuation of an exercise regime. On the other hand, these changes underline the importance of following an exercise programme and maintaining activity levels into older age.

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With that in mind, we now need to explore exactly what type of exercise we should be doing, and how often. The NHS guidelines for exercise for the over-65s are (link):

• Aim to be physically active every day. Any activity is better than none. The more you do the better, even if it's just light activity.

• Do activities that improve strength, balance and flexibility at least 2 days a week.

• Do at least 150 minutes of moderate-intensity activity a week or 75 minutes of vigorous-intensity activity if you are already active, or a combination of both.

• Reduce time spent sitting or lying down and break up long periods of not moving with some activity.

Of the four points made above, the guidelines regarding strength training and intense activity are of particular importance and require additional discussion. Flexibility and mobility training is not mentioned above but, considering the positive effects on balance, coordination and relaxation, should be included (8).

Cardiovascular exercise aims to improve the efficiency of the heart and lungs. These changes come about as the heart becomes stronger, blood vessel networks open up lowering blood pressure and lung capacity can increase. All of these changes are beneficial for humans of all ages, but for those experiencing the effects of ageing, the benefits could be even greater. A recent study suggested that regular cardiovascular exercise can help to limit, or even reverse, stiffening of the heart - a normal effect of the ageing process (9).

Strength training aims to improve strength and muscle tone. These changes happen as exercises are performed against resistance and the subsequent effect of supercompensation by means of increased muscle fibre size, improved neuromuscular pathway and increased motor neuron recruitment. The effects of ageing leave us susceptible to postural issues, difficulty performing day-to-day tasks and an increased risk of falling. An improvement in muscle strength and control, therefore, is of utmost importance as we get older.

Flexibility and mobility are important in the fight against chronic pains and muscle stiffness. It can also help to improve circulation, reduce the risk of injury and aid in relaxation (10). Guidelines for stretching vary with the desired effect but stretching for 30-60 seconds after exercise has been shown to be beneficial for almost everyone (11).

So, how do we put this information together to provide the best advice for exercising in older age? The basic answers are:

• Exercising to improve the efficiency of the heart and lungs can be achieved by jogging, swimming, rowing, hiking, gardening and aerobics, amongst others.

• Strength training exercises involve movements performed against a resistance - often gravity - which works the muscles such as squats, push-ups and abdominal exercises, to name but a few.

• Stretch after your workouts focusing on problem areas, most commonly: hamstrings, upper back, glutes and hip flexors.

Basic isn’t good enough, however. There are ways to incorporate the principles above and exercise in a manner that combines the two and adds functionality and usefulness into the equation. Let me put it this way.

Cardiovascular exercises should have a point. It is pretty straightforward to raise the heart rate through movement, so why not incorporate a useful skill into the exercise? Martial arts or self-defence and swimming are two skills that could potentially save your life. They are also fun, interesting and social exercises that help to achieve the same effect as “basic” cardiovascular exercises.

Functional strength training focuses on strengthening the body by performing movement patterns that have a high degree of carry-over to day-to-day activities or the specific movement requirements of work and sports. Think standing up from a chair, rising from the floor, lifting and carrying awkward objects and balance-orientated movements. Movements like these help to strengthen the body as a whole whilst potentially making daily tasks easier and reducing the risk of injuries. Performing these exercises correctly can also help to improve your mobility and flexibility. A strong muscle is a flexible muscle and focusing on the correct exercise form can have a drastic effect on your mobility and posture.

Now, assuming daily, non-exercise activity levels are high (they should be!) not everyone has the time or freedom to programme in 4-5 training sessions per week. The good news is that by manipulating the order of functional strength training exercises and by minimising the rest periods between exercises you can achieve improvements in both cardiovascular health AND muscular strength and function. This reduces the number of training sessions needed per week to meet the recommended guidelines and frees up time for other hobbies and activities. Include a relaxing, targeted stretching routine to the end of your session and you potentially have the most efficient exercise programme to help you in older age.

The human body is designed to move and move frequently. Regardless of age, movement has been, and always will be, one of the best ways to stave off poor health and remain functionally mobile. In populations with a large percentage of the population living well into their 80’s, “constant moderate physical activity” has been identified as a common constituent to their longevity (12). For them, it is a part of life, so the sooner we make it a part of ours the better chances we have of being fitter and healthier in older life.