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20 Minutes Daily exercise at age 70 may reduce heart disease risk
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Conclusion
Physical activity among older people was associated with a reduced risk of CHD and heart failure, especially early in late life. Lower incidence rates of CVD were found among both physically active men and women. No significant association between physical activity and stroke was observed. Physical activity and increasingly active trajectories of physical activity were also associated with a significantly lower mortality risk in both men and women. These results suggest that public health policies should be targeted at promoting or beginning physical activity in mid- and early late life, given a probable greater effectiveness in reducing cardiovascular risks. At least 20 minutes of moderate to vigorous physical activity per day should be recommended to achieve the greatest cardiovascular benefits.
When stratifying by age, we found that the association between physical activity and cardiovascular risk was significantly reduced among participants aged 70 years, and with marginal significance at 75 years, while no association was found among the oldest age groups, suggesting greater cardiovascular benefits might be achieved by improving physical activity earlier in late life
The greatest cardiovascular risk reduction was observed for >20 min/day of physical activity, and was more marked at 70 years.
Increasing levels of physical activity trajectories were also associated with a lower incidence of CVD, suggesting that improving and maintaining an active status even in advanced age should be recommended.
Physical activity was associated with a significantly lower risk of CVD (fully adjusted HR 0.74, 95% CI 0.58 to 0.94), CHD (HR 0.66, 95% CI 0.50 to 0.87) and heart failure (HR 0.72, 95% CI 0.53 to 0.98) in men (table 2).
Physical activity was associated with a significantly reduced risk of overall mortality in both men and women (HR 0.72, 95% CI 0.62 to 0.84 and HR 0.81, 95% CI 0.72 to 0.92, respectively)
With regard to the association of physical activity at different ages with the risk of any cardiovascular outcome, we found significantly reduced risks among men, only at age 70 (HR 0.58, 95% CI 0.39 to 0.84) and limit to significance at age 75 (HR 0.74, 95% CI 0.52 to 1.05),
There was no relationship between physical activity and stroke risk. Adding prevalent cases of CVD at baseline did not change the results.
Mechanisms underlying the beneficial effects of physical activity on cardiovascular health are well known and can be attributed to numerous biological modifications. These include enhanced mitochondrial function, restored and improved vascular conditions and the release of myokines from skeletal muscle that enhance or preserve cardiovascular function.29 These modifications are likely to be more effective when the overall cardiovascular status has not been compromised by a long-lasting sedentary lifestyle. Moreover, the fact we found a significant association of physical activity with cardiovascular outcomes only early in late life could be attributed to the need for a longer exposure to an active lifestyle in order to modify cardiovascular risk profiles.25 30
In fact, compared with participants with stable-low trajectories, all other trajectories—and especially stable-high trajectories—had lower rates of incident CVD. Moreover, the results from this study suggest that the earlier people engage in physical activity, the greater reduction in incident CVD they may achieve.
Moreover, the results from this study suggest that the earlier people engage in physical activity, the greater reduction in incident CVD they may achieve. Conversely, the absence of any association with stroke has also been observed in a previous study.11 Despite the fact that stroke shares numerous risk factors with CVDs, including physical activity, an active lifestyle among older people could increase the risk for specific types of stroke such as haemorrhagic stroke deriving from vascular traumas, and results from previous literature have in fact been inconsistent.5 25
The risk reduction of any incident cardiovascular event associated with at least 20 min of physical activity per day was most marked at 70 years, and only moderately reduced at 75 years, while no significant correlation could be observed at 80 and 85 years
Moderate physical activity included walking, playing games that require moderate physical exercise such as bowls, and fishing. Vigorous physical activity included gardening, gym work, biking, dancing and swimming. Hours of moderate and vigorous physical activity were then transformed into min/day, calculated as moderate + 2*vigorous physical activity.
Participants were then defined as active or inactive if they engaged for >20 min/day or ≤20 min/day.
Four types of trajectories were defined: stable-low (inactive-inactive), high-decreasing (active-inactive), low-increasing (inactive-active) and stable-high (active-active).
At baseline, women were more likely to have more than four comorbid conditions and had an especially higher prevalence of osteoarthrosis, osteoporosis and chronic kidney disease, while chronic obstructive pulmonary disease and diabetes were more common among men.
Women doing more physical activity had consistently lower incidence rates of almost all cardiovascular outcomes despite the fact that the risk reduction did not reach statistical significance, but when considering overall mortality, risks were significantly reduced. Although the magnitude of the studied associations was greater among men, the risks of CHD and heart failure were also moderately reduced after longer daily exposure to physical activity in women, as previously reported in the literature.3 However, despite the fact that sex-based differences of physical activity on cardiovascular health have been previously reported,26there is strong evidence in support of a positive effect of physical activity on cardiovascular risk reduction in both men and women.3 27 28
Trajectories of physical activity, categorised by increasingly active status over time (stable-low, high-decreasing, low-increasing and stable-high), were associated with a lower risk of incident CHD and heart failure among men (p for trend 0.005 and 0.038, respectively), as shown in table 3 and online supplemental figure 5. Although risk reduction was non-significant among more physically active women, the rates of incident CHD and heart failure were always lower for participants with low-increasing and stable-high levels of physical activity, as opposed to high-decreasing and stable-low physical activity. When these trajectories were observed at different ages from baseline, a trend of significantly reduced risks of any major incident cardiovascular event was found among men at 70 and 75 years (p for trend 0.002 and 0.025, respectively), as shown in online supplemental table 4. Among women at different ages, the association of increasing levels of physical activity trajectories with any cardiovascular outcome did not reach statistical significance, while risks for overall mortality were significantly reduced (see online supplemental table 3 and online supplemental table 4).
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