June 29, 2016

expert reaction to effect of exercise on cardiovascular health in the elderly

A study published in JAMA Cardiology investigated the impact of exercise on the risk of cardiovascular events in the elderly, and reported that exercise had no significant reduction in the risk of heart disease.

Dr David Nunan, Departmental Lecturer and Senior Researcher at the Centre for Evidence Based Medicine, University of Oxford, said:

“The LIFE Study Randomised Trial originally set out to determine if a structured physical activity intervention that matched national guideline recommendations was more or less effective at minimising the impact of age related disability in frail, elderly people. The original study found that physical activity had a beneficial effect on elderly people’s disability when compared to health education alone.

“In the latest analysis from this trial the authors report on tertiary outcomes including cardiovascular events and death. They found that physical activity had no beneficial effect on these outcomes. The study conforms with good reporting standards (e.g. pre-registration, published protocol), was well conducted and demonstrates a low risk of bias for all important elements relevant to the type of study performed (RCT). This means that the results are likely to be valid and trustworthy.

“These findings are important because they provide more robust, yet contradictory evidence of the effectiveness of physical activity as a single intervention on clinically relevant outcomes which has to date predominantly been underpinned by evidence from observational studies. The study is however limited by the small sample size, thus low number of events, as discussed by the authors, indicating the need for a larger trial to demonstrate replication.

“The present study adds to a growing body of high quality trials, such as the Look AHEAD trial, that suggest little or no benefit of physical activity and exercise as a single intervention for prolonging life in middle-aged and elderly healthy or high-risk populations. As such, there may be a need to temper current guideline and evidence-based recommendations highlighting a longevity benefit from physical activity.

“However, it is important to re-iterate that the recent trial evidence, including the current LIFE study, does support physical activity as an effective intervention for improving the quality of remaining years of life in adults, both healthy and with chronic lifestyle-related disease, and efforts to promote physical activity for this outcome should be encouraged.”

Dr Tim Chico, Reader in Cardiovascular Medicine at the University of Sheffield, said:

“This study showed that you are never too old to increase your level of physical activity, and that this reduces the risk of future physical disability. Although this study didn’t see a reduction in the risk of heart disease in people who had increased their levels of physical activity late in life, the differences between groups was rather small; the “active” group only did 40 minutes more moderate activity than the “inactive” group. Given this small difference, and the fact that the study only lasted for 31 months, I don’t think it is possible to conclude that increasing physical activity can’t prevent heart disease in the elderly. I remain convinced by the extensive evidence that shows lifelong physical activity reduces your risk of heart disease by about half, which is more than any drug or medical treatment can achieve.

“There is no ‘do this, eat that’ magic bullet to prevent heart disease. Rather there is an holistic ‘heart-healthy’ lifestyle that includes regular physical activity, a healthy diet, avoiding weight gain and not smoking.”

‘Cardiovascular Events in a Physical Activity Intervention Compared With a Successful Aging Intervention’ by Anne Newman et al. published in JAMA Cardiology on Wednesday 29 June 2016. 

Declared interests

Dr Tim Chico: “I am a committee member and Treasurer of the British Atherosclerosis Society, a charity established in 1999 to promote UK atherosclerosis research.”

Dr David Nunan is a lead member of the Royal College of General Practitioners (RCGP) steering committee to support the new Physical Activity and Lifestyle clinical priority.  Dr Nunan has received funding for research from the NHS National Institute for Health Research School for Primary Care Research (NIHR SPCR) and the RCGP for independent research projects related to physical activity and dietary interventions.  The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or the RCGP.