News & Views from the Editor-in-Chief: Andrew M. Jones
One of the key strengths of MSSE is the diversity of its content: from disease, through health, to high performance; and from basic mechanisms to applied practice. This issue is no exception, with articles on a wide range of interesting topics. However, this month I have chosen to feature three articles with a focus on the importance of fitness and physical activity for healthy aging.
Maximal oxygen uptake (VO2max) is a hallmark of aging resiliency strongly associated with mortality. Published non-exercise prediction equations are often used when maximal exercise testing is infeasible. In 'Validation, Recalibration, and Predictive Accuracy of Published VO2max Predictive Equations for Adults Ages 50 – 96', Schumacher and colleagues assessed the accuracy and predictive performance of 12 equations against measured VO2max among 1080 adults aged > 50 in the Baltimore Longitudinal Study of Aging (BLSA). The equations yielded reasonable performance metrics, especially after recalibration in the BLSA. Measured VO2max, but not predicted VO2max, was associated with mortality after adjustment for age and sex. These findings suggest that the equations fail to capture the underlying physiologic resiliency parameters of measured VO2max in the prediction of health outcomes independent of age and sex.
As we continue to learn about the health benefits of leading a physically active lifestyle, it is also important to understand potential mechanisms that might explain these health benefits. In their article, 'Association of Accelerometer-measured Physical Activity and Sedentary Time with Epigenetic Markers of Aging', Spartano et al. examined three epigenetic (DNA methylation) patterns in 2435 middle-aged adults from the Framingham Heart Study. The authors observed that people who spend more time walking and less time sitting actually have fewer markers of aging, as measured by epigenetic patterns. They also observed that the composition of white blood cells and an individual's body composition may partially explain these associations. It will be important for future studies to explore how these epigenetic changes may confer health benefits.
Data is scarce on the benefit-cost ratio of long-term supervised exercise programs in middle-aged individuals with metabolic syndrome (MetS). In 'Effect of Yearly Exercise on Medication Expense and Benefit-Cost Ratio in 2 Individuals with Metabolic Syndrome: A Randomized Clinical Trial', Morales-Palomo and colleagues measured the effects of exercise on pharmacological expenses and health evolution in a group of 64 patients (29% women). Five consecutive years of supervised aerobic high-intensity training (4 months per year) resulted in an improved health condition with the initial dose of medication maintained. In contrast, the non-exercise control increased the number/dose of medications by 89%. The benefit in medicine savings per year was several fold greater than the estimated cost of the exercise intervention (benefit-cost ratio = 3). These findings justify the inclusion of exercise to improve the clinical management of MetS. These data, scaled up to the medicated world population with MetS, predicts a major economic impact of supervised exercise.
Andrew M. Jones
University of Exeter