Structured Exercise Program Can Help the Sedentary Elderly but Does Not Curb CV Events

Older, frail individuals who are encouraged via a structured exercise program to stop being sedentary and start getting more physically active do not see their efforts translate into a lower risk of cardiovascular disease events, according to a fresh look at data from the Lifestyle Intervention and Independence for Elders (LIFE) trial.

“At the end of the day, it’s a very modest amount of physical activity in a very old population,” Benjamin Levine, MD (Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital and UT Southwestern Medical Center, Dallas, TX), who wasn’t involved in the study, told TCTMD. “So it shouldn’t surprise anybody that a little bit of exercise initiated very late in life isn’t going to have a major effect."

The LIFE study, originally published in JAMA in 2014, showed that an exercise program could lessen participants’ risk of mobility disability. The new findings focused on the risk of cardiovascular disease events were published online June 29, 2016, in JAMA Cardiology.

Physical Activity vs ‘Successful Aging’

LIFE, conducted at eight US centers from 2010 to 2013, involved 1,635 participants ages 70 to 89 years who had an inactive lifestyle, which was considered fewer than 20 minutes of regular physical activity per week. To qualify, they also had to be capable of walking 400 meters in 15 minutes or less without needing to sit down.

Participants were randomly placed in the physical activity intervention group or in the “successful aging” group.

The first group received physical activity intervention in the form of walking 150 minutes/week as well as strength, flexibility, and balance training. They were also expected to join two sessions at one of the eight centers as well as independent activity an additional three or four times a week. The successful aging group only attended workshops on health education for the first 26 weeks, then monthly after that.

For the current analysis, the investigators looked at cardiovascular disease events: a composite of fatal and nonfatal MI, angina, stroke, transient ischemic attack, and peripheral artery disease adjudicated by committee plus silent ischemia assessed by serial electrocardiograms.

Despite finding improved mobility and cognitive function in the participants, there was no reduction in cardiovascular disease events associated with physical activity. Events occurred at a rate of 14.8% in the physical activity group and 13.8% in the successful aging group. There also were no differences when focusing on a narrower composite endpoint of MI, stroke, or cardiovascular death, or when looking at frailer patients.

To Exercise or Not to Exercise

Irrespective of these findings, the guidelines for physical activity and the findings of previous trials involving older participants have highlighted several benefits of physical activity including lower blood pressure, improved weight and mobility, and limited improvement in cognitive functions.

“We had hoped to see a trend for reduced heart disease events, given the strong positive finding for reduced mobility disability, previously published in JAMA,” lead author Anne Newman, MD (University of Pittsburgh, PA), told TCTMD in an email. “The lack of a difference could mean that physical activity needs to start earlier in life to prevent cardiovascular disease, or it could mean that more exercise is needed than what we provided in this study.”

Even with the results of the study, exercise remains a key component to preventative health and overall wellbeing especially for older individuals. Newman also pointed out that most studies on exercise don’t include older adults, especially those at a high risk of disability, and that the lack of evidence to show exercise reduces risks of CV should not be a deterrent.

“Studies of cardiac rehab do show that recurrent heart attacks are prevented with exercise,” Newman said. “The major benefit of a walking program for people over 70 is in reducing disability and improving mobility.”

Newman also emphasized the fact that the LIFE trial was the “longest-term and largest study of exercise in frail older people,” and that additional studies on the group would reveal more about the health benefits of exercise for this under-studied demographic.

The need to continue studying exercise in older populations can also have a different kind of impact, according to Gerald Fletcher, MD (Mayo Clinic, Jacksonville, FL), who also commented on the study for TCTMD. He also thinks the outlook for studying physical activity in older adults is good.

Researchers “are doing more and more studies on them,” Fletcher said. “This keeps the public interested, if they can see that we are still doing research in [exercise]. We . . . know it’s important, and it’s on the agenda of all of us who are dealing with patients.”

Michael H. Wilson is the 2016 Recipient of the Jason Kahn Fellowship in Medical Journalism.

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