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Tuesday, September 30, 2014

Can long standing endurance exercise training mitigate the of age related loss of compliance of left ventricle?

With more evidence available to generate legitimate concern about an increased risk of atrial fibrillation with  many years of endurance exercise and papers about long time endurance athletes and the  much less likely risk of developing arrhymogenic right ventricular dysplasia (ARVD), some good news for the crazy, old long distance runners was very welcome.

Here is a link to summary of the paper by Dr. Paul Bhella et al. entitled "Impact of Lifelong Exercise "dose" on Left Ventricular Compliance and Distensibility"

Here is the authors'conclusion :

" Low doses of casual, lifelong exercise do not prevent the decreased compliance and distensibility observed with healthy, sedentary aging. In contrast, 4 to 5 exercise sessions/week throughout adulthood prevent most of these age-related changes. As LV stiffening has been implicated in the pathophysiology of many cardiovascular conditions affecting the elderly, this "dose" of exercise training may have important implications for prevention of cardiovascular disease."

Is there an age related decrease in left ventricular compliance.  According to a 1984 article by Rodeheffet et al the aging heart may be able to maintain cardiac output in the face of an age associated decrease in maximal heart rate by increasing stroke volume. See here for link. The older person relies more on an increase in end diastolic volume and riding the beneficial part of the Starling curve, but if the left ventricle become less compliant, which it is claimed it does as a function of age that adaptation would only work for a while.

Is the decrease in LV compliance due to just getting old or might it be due to lack of vigorous physical exercise. Dr. Armin-Zaeh and coworkers at the Dallas Based Institute for exercise and environment medicine  believe  it is the latter. See here.  My personal bias is obviously to agree with them. Here are the conclusions from the above linked article.

"In conclusion, a sedentary lifestyle is associated with a decline of ventricular compliance, leading to higher cardiac filling pressures and lower stroke volumes for a given filling volume compared with age-matched athletes or young individuals. Prolonged, sustained endurance training preserves ventricular compliance with aging and may be an important approach to reduce the probability of heart failure with aging."

A partial,apparent  counterpoint to the  above studies can be found here in this 2003 article by  P E Gates and co-authors whose analysis and summary minimized the importance of one of their own findings  ( namely that a standard measure of diastolic function (the e/a ratio) was higher in endurance trained subjects) and instead emphasized the value of the decreased arterial stiffness noted in long term exercisers.Either way, a less stiff ventricle and/or a less stiff aorta, it is  good news to long term endurance exercisers.

addendum: 10/1/14 Correction made on title, "Stiffness" changed to "Compliance"
addendum-1/22/14 Title reworded to a less awkward version 

addendum; 10/4/15 An article by Daniel Forman  entiltted "Enhanced left ventricular filling associated with long term endurance exercise." The title tells their conclusion . The link below is just for an abstract so I cannot comment on the data or how well their summary captures the data. or how old the masters were. The authors state "Early ventricular filling indices in master athletes more closely resemble transmitral flow patterns of health young adults." (Journal of Gerontology 1992, 47 2)

1 comment:

John Doe said...

I guess it would dear doc. Well, as we grow old, there are so many changes in our body and we need to do an exercise as much as possible. You are a retired doctor and I do believe that you have so many experiences in your career.

John Doe