Abstract
Aging is associated with significant changes in both cardiac and vascular structure and function that lower the threshold for clinical signs and symptoms, making older people more susceptible to cardiovascular diseases, morbidity and mortality. Understanding of age-related cardiovascular changes is necessary for effective and efficient prevention and treatment of cardiovascular disease in older people. Cardiac aging is associated with left ventricular remodelling marked by increased mass-to-volume ratio and accompanied by systolic and diastolic myocardial dysfunction, and reduced sensitivity to sympathetic stimuli that compromises myocardial contractility and pumping ability in older people. The vascular age-related remodelling is associated with increased arterial wall thickness, arterial stiffness, and an impaired endothelial vasoreactivity. Over the previous three decades of intensive research in cardiovascular aging, it became apparently clear that lifestyle factors such as physical activity and exercise play an important role in attenuating cardiovascular function decline with aging. This review highlights the effect of age on cardiac and vascular changes and their adaptations to exercise, providing physiological, molecular and cellular mechanisms that underlie diminished cardiovascular response in older age. It further describes cardiovascular differences between the individuals who maintain a physically active lifestyle, and who undergo exercise interventions in later life.
Highlights
Over the previous three decades of intensive research in cardiovascular aging, it became apparently clear that lifestyle factors such as physical activity and exercise play an important role in attenuating cardiovascular function decline with aging
This book chapter will provide an overview of the evidence demonstrating the physiological and molecular responses and adaptations in cardiovascular function induced by physical activity and exercise in relation to aging
Cardiac aging is associated with progressive loss of cardiomyocytes and compensating mild hypertrophy, and with reduced sensitivity to sympathetic stimuli that compromises myocardial contractility and pumping ability in older people
Summary
One of the most important physiological changes that occur in response to advanced aging is a decline in maximal aerobic capacity (i.e. cardiorespiratory fitness) represented by peak exercise oxygen consumption. The gender differences dissipate in the later decades of life, suggesting a significant difference in age-associated changes in cardiac morphology and function between men and women and their response to acute exercise stress test (Lakatta and Levy, 2003a; Olivetti et al, 1995; Fleg et al, 1995a; Goldspink et al, 2009; Cheng et al, 2009; Ridout et al, 2010). Elevated sympathetic neurotransmitter levels lead to a greater occupancy of cardiac cell surface receptors by the catecholamine, leading to a desensitization of the β-adrenergic receptor and its coupling to intracellular signalling pathways (Lakatta, 1993) Such desensitization accounts for the postsynaptic reduction in responsiveness to β-adrenergic stimuli with aging as demonstrated with reduced maximal heart rate and cardiac dilation during stress
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