Abstract
Aging is a well-known cardiovascular risk factor and cardiovascular diseases (CVD) are estimated to be the most common cause of death in the elderly. Peripheral arterial disease (PAD) represents an important clinical manifestation of CVD leading to increase morbidity and mortality, especially in elderly population. The correct management of PAD population includes the prevention of cardiovascular events and relief of symptoms, most commonly intermittent claudication. Progressive physical activity is an effective treatment to improve walking distance and to reduce mortality and cardiovascular events in patients with PAD, however the ability to effectively engage in physical activity often declines with increasing age. The maintenance and increase of reserve functional capacity are important concepts in the elderly population. Ultimately, the goal in participation of physical activity in the healthy elderly population is maintenance and development of physical functional reserve capacity. Therefore, for individuals suffering of PAD, appropriate physical activity in the form of supervised exercise may serve as a primary therapy. Although there are few direct comparisons of therapeutic exercise programs vs. pharmacological or surgical interventions, these increases in walking distance are greater than those reported for the most widely used agents for claudication, pentoxyphylline, and cilostazol. Despite a reduction in mortality and improvement of quality of life caused by physical activity in the PAD population, the molecular, cellular, and functional changes that occur during physical activity are not completely understood. Therefore, this review article aims at presenting an overview of recent established clinical and molecular findings addressing the role of physical activity on PAD in the older population.
Highlights
Aging is a well-known cardiovascular risk factor and cardiovascular diseases (CVD) are estimated to be the most common cause of death in the elderly
Large epidemiological studies have shown that Peripheral arterial disease (PAD) and an abnormal anklebrachial index (ABI), in addition to be an important cause of disability in its symptomatic forms, are associated with an elevated risk of developing severe cardiovascular disease in both symptomatic or asymptomatic patients (Suominen et al, 2008; Giugliano et al, 2012a,b,c,d; Schiano et al, 2012; Marsico et al, 2013)
PAD is a widespread cause of disability in the elderly population in the Western world
Summary
Physical training exerts significant preventive actions against the development of PAD, in the elderly. PHYSICAL ACTIVITY PREVENT PERIPHERAL ATHEROSCLEROSIS As described above, physical activity allows a better control of atherosclerotic risk factors (lower blood pressure, increased HDLC, increased glycemic control etc.) and preserves vessel integrity by restoring endothelial function Another mechanism potentially involved into exercise induced prevention from vascular remodeling regards a decrease in vascular tone, due to a slighter sympathetic system activity (Dinenno et al, 2000). Cilostazol, naftidrofuryl, and pentoxifylline are arterial vasodilatant agents, while l-propionylcarnitine is an amino acid naturally produced in the body whose biological function is to promote fat acid β-oxidation by enabling acil-CoA transport into mitochondria- so, its action is related to an improvement of metabolism into ischemic skeletal muscles None of these drugs acts preserving vascular integrity, such as exercise training, as widely described above. There are some limitations to training therapy, especially in older subjects, including the presence of muscular, articular, and/or neurological diseases, and cardiac and/or pulmonary diseases can be limiting factors
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