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You Asked for It: Question Authority

Nieman, David C. Dr.PH, FACSM

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David C. Nieman, Dr.PH, FACSM, is professor and director of the Human Performance Laboratory, Appalachian State University, in Boone, NC, an active researcher, and author of several textbooks on health and fitness. E-mail your questions to niemandc@appstate.edu.

Q: Can aerobic training improve heart and lung fitness even on old age?

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A: Yes, regular aerobic training can help elderly individuals attain aerobic fitness levels equal to untrained people much younger than themselves. In fact, aerobic training improves fitness and function well into the seventh and eighth decades of life. This is good news to the burgeoning population of senior citizens.

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An Aging America

Although Americans idolize youth and spare no expense to regain it, the United States is now regarded by experts as an "aging society." In colonial times, for instance, the average age of the population was 16 years. Today it is 33 years and will grow to 42 years in 2030 (1).

During the last century, dramatic improvements in life expectancy (i.e., the expected number of years of life at a given age) have been experienced in many countries worldwide. In the United States, for example, life expectancy has increased from 47 to over 77 years during the past nine decades and is expected to exceed 82 years by the year 2050 (1). In 1900, only 40% of Americans lived beyond age 65, a proportion that has now doubled to 80%.

The key issue, caution scientists who study aging, is that of quality of life. The National Center for Health Statistics has estimated that 15% of the life of the average person in the United States, or approximately 13 years, is spent in an "unhealthy" state (i.e., impaired by disabilities, injuries, or disease) (2). Nearly 85% of the elderly suffer from one or more diseases or health problems. More than 10% of the elderly have some form of senile dementia, especially Alzheimer's disease. The most frequently occurring health problems among the elderly are arthritis, high blood pressure, heart disease, lung diseases, diabetes, and cancer.

The aging process varies widely among people and is influenced by both lifestyle and genetic factors. Aging experts believe that humans could live to 115 to 120 years on a regular basis if both the lifestyle and genetic backgrounds were optimal. Several people have lived to 120 years of age or more. Arthur Reed of Oakland, California, lived to be 124 years of age. In 1997, Jeanne Calment of France died at age 122.

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Improve Aging Through Activity

Exercise, diet, smoking, and other health habits have a strong effect in improving both the length and quality of life. A key ingredient to healthy aging, according to many gerontologists (i.e., those who study aging), is regular physical activity (3). Of all age groups, the elderly have the most to gain by being active. The risk for many diseases and health problems common in old age is decreased with regular physical activity.

Regular exercise also can decrease body fat, increase muscle strength, and improve aerobic fitness (3, 4). Fit elderly people can take better care of themselves and engage in the common activities of life. Elderly people who exercise regularly report they sleep better, are less vulnerable to viral illnesses, and have a better quality of life than their sedentary friends. However, national surveys indicate that only approximately one fourth of the elderly population exercises regularly, less than any other group (2).

Much of the deterioration attributed to aging is instead now linked to physical inactivity. Nonetheless, the aging process is real, and although remarkable amounts of body function and fitness can be attained in old age, inevitably, aging always wins. The goal is to push back frailty to a very small part of the life experience, or as the philosopher Ashley Montagne has urged, "To die young as late in life as possible."

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V̇O2max Issues
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Most researchers who have evaluated the effects of aging on the cardiorespiratory system have focused on maximal aerobic fitness, or V̇O2max (4). The ability of the body to take in oxygen, transport it, and use it to burn fuel is seen by many as the single best measure to represent the changes that occur in the body with aging. V̇O2max normally declines 8% to 10% per decade for both men and women after 25 years of age. Approximately half of this decrease has been related to people exercising less and getting fatter as they age (4).

Despite this, at any given age, people can have a much higher V̇O2max if they exercise vigorously and keep lean. Master athletes who are 65 to 75 years of age can have the V̇O2max of young sedentary adults, and are capable of performing at levels once thought unattainable (5).

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However, even among athletes who exercise vigorously throughout their lifetimes, V̇O2max still declines at a similar rate to that of sedentary individuals (albeit at a much higher absolute level). Some studies have demonstrated that the rate of decline may be lessened for up to 20 years because of regular, vigorous endurance exercise, but if subjects are followed long enough, V̇O2max will start falling at normal or accelerated rates because of a lack of desire to keep training hard (5).

Researchers from Ball State University studied former elite distance runners over a 22-year period and found that regardless of how much they trained, all lost aerobic fitness (6). Those who trained the hardest were able to push back the rate of decline a bit, but this worked best for middle-aged, not elderly, runners.

In other words, there are no convincing data at this time that the age-related decrease in aerobic fitness can be prevented through regular endurance exercise training. The aging process is real, and several changes in the body, including a decrease in the ability of the heart to pump blood at a high rate and the capacity of the muscles to use oxygen, are linked to the age-related decline in V̇O2max. The bottom line is that at any given age, athletes who exercise vigorously can be fitter than their sedentary counterparts, but because of the aging process, they will be less fit than younger athletes.

Most studies indicate that untrained people even in their eighth decade of life have not lost the ability to adapt to aerobic exercise training (7). In other words, it is never too late to improve from an untrained to a trained state. Although earlier studies suggested that older individuals were not as responsive to aerobic training as their younger counterparts, there is now a growing consensus that gains in aerobic fitness are similar, albeit at a lower level for the elderly. In general, the same basic exercise programs used for young adults can be applied to the elderly, but with an emphasis upon greater caution and slower progression.

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References

1. U.S. Centers for Disease Control and Prevention. Public health and aging: trends in aging-United States and worldwide. Morbidity and Mortality Weekly Report 52(6):101-106, 2003.

2. U.S. Department of Health and Human Services. Healthy People 2010. Washington DC: January, 2000. Available at http://www.health.gov/healthypeople/.

3. Shiraki, K., S. Sagawa, and M.K. Yousef. Physical Fitness and Health Promotion in Active Aging. Leiden, The Netherlands: Backhuys Publishers, 2001.

4. Hawkins, S., and R. Wiswell. Rate and mechanism of maximal oxygen consumption decline with aging: implications for exercise training. Sports Medicine 33:877-888, 2003.

5. Tanaka, H., and D.R. Seals. Invited review: dynamic exercise performance in Masters athletes: insight into the effects of primary human aging on physiological functional capacity. Journal of Applied Physiology 95:2152-2162, 2003.

6. Trappe, S.W., D.L. Costill, M.D. Vukovich, et al. Aging among elite distance runners: a 22-yr longitudinal study. Journal of Applied Physiology 80:285-290, 1996.

7. Lemura, L.M., S.P. von Duvillard, and S. Mookerjee. The effects of physical training on functional capacity in adults. Ages 46 to 90: a meta-analysis. Journal of Sports Medicine and Physical Fitness 40:1-10, 2000.

© 2004 American College of Sports Medicine

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