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Monday, November 2, 2009

Aging and Cardiovascular Fitness

Cardiorespiratory Fitness Declines With Age, No Matter What

Here's the bad news: no matter what you do, what exercise regimen you adopt, how carefully you eat, the capacity of your heart and lungs, so-called cardiorespiratory fitness, will decline as you age. And the point of no return, when the decline happens much more sharply, is 45 years of age. That's in this issue of Archives of Internal Medicine: Role of Lifestyle and Aging on the Longitudinal Change in Cardiorespiratory Fitness.

We already knew that cardiovascular capacity diminished over time, with one very noteworthy study of male marathon runners demonstrating this fact with astonishing clarity. Now these researchers have examined data from almost 20,000 men and women (almost 35oo women!) enrolled in the Aerobics Center Longitudinal Study, including treadmill test results and data from comprehensive medical examinations. Study participants ranged in age from 20 to 96 years.

Results indicate that age 45 is the point of no return (shoot me now). That's when the rate of decline accelerates. Cofactors that make the decline even more precipitous include those well-known demons : smoking, obesity, and a sedentary lifestyle. People who did not smoke, didn't have a body mass index (BMI) greater than 25 and who exercised fairly strenuously on a regular basis preserved their cardiorespiratory fitness best. Clearly, the results indicate once again that you are in charge of your own health, and that choices you make will absolutely determine how well you age.

This last is also important from a societal perspective. People aged 80 and older comprise the fastest growing segment of our population, and we are all vested in how well they age, and how to keep them well until the end of life. The current healthcare debate has brought to the fore the fact that the biggest Medicare expenditures occur in the last six months of life. A generally healthier older population would likely reduce this outlay. Finally, more efforts need to be targeted toward prevention of obesity and smoking as well as adoption of a more active lifestyle in younger folks.

Other topics this week include risks related to use of so-called 'atypical antipsychotic' medications in children in JAMA, staving off type 2 diabetes in the Lancet, and the best insulin regimen for managing diabetes in NEJM. Until next week, y'all live well.

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