Exercise as it relates to Disease/Cardiovascular disease exercise interventions in the elderly population

This WikiBook is an analysis and critique of the article: Amidi CB, Trevisan C, Dotto M, Ferroni E, Noale M, Maggi S, Corti MC, Baggio G, Fedeli U, Sergi G. Association of Physical activity trajectories with major cardiovascular diseases in elderly people. Heart. (18.11.2022) https://heart.bmj.com/content/108/5/360#ref-18

What is the background to this research?

 * The research is about the physical exercise levels of the elderly population (65 years and above) in Italy. Baseline assessments were taken from participants between 1995-1997, with follow-up assessments being taken every 4-7 years (until 2018). Participants with prevalent coronary heart disease, heart failure or stroke at the baseline assessment were excluded from the study.


 * At each follow-up assessment, thorough medical history and physical examinations were performed, as well as biohumoral and radiological tests.


 * Questionnaires were also given out to the participants at each follow-up to measure their physical activity levels


 * Morbidity and mortality surveillance was also conducted up until December 2018

This research is produced from over decades of research, taking note of all participants physical variables at every follow-up, while also showing what exactly physical activity may affect and how at certain points of elderly life.

This research is important not just for the most elderly population, but for all to learn from, to understand how exercise can prolong our lives and even how late is too late to prevent heart disease and heart related issues.

Where is the research from?

 * The research was conducted in Italy with 3099 participants, all aged 65 and above


 * The research was conducted from 1995 until 2018

Most of the authors of the research have multiple research papers published, with all authors being heavily involved in the health field.

There are many contributors to the study, with most being either universities, health care companies or philanthropic organisations. The one possibility of conflict of interest is the local council (Veneto regional authority) which could try to skew the finding to be more in favour of healthy and more well looked after elderly population. However, the article states that no sponsor had a roll in the design, methods, subject recruitment, data collections, or analysis and preparation of the paper. As well as the article also taking note of the participants economical and educational status.

What kind of research was this?
The research was done as a cohort study, with questionnaires given to the participants to record their physical activity at each ‘follow-up’ appointment.

The level of evidence from this sort of study can differ from others that are a lot more ‘hands-on’ as participants are only asked to recall their physical activity at the follow-up assessments, rather than recording every day, using an accelerometer or more regular follow-ups. Due to this, evidence may have been collected better.

What did the research involve?

 * The participants would come back for follow-up assessments every 4-7 years as stated in ‘background to the research’.


 * They would be given questionnaires about how many hours were spent each week on activities (while also stating what activities they participated in), which was categorised as either moderate or vigorous.


 * Hours of moderate and vigorous activity were then turned into minutes/day and calculated as moderate + 2x vigorous physical activity.


 * After this, participants were then defined as active (above 20 minutes per day) or inactive (below 20 minutes per day).


 * Physical activity trajectories were then identified in 4 trajectories:


 * 1) Stable-low (inactive-inactive)
 * 2) High-decreasing (active-inactive)
 * 3) Low-increasing (inactive-active)
 * 4) Stable-high (active-active)


 * Participants were then put into these categories based on their questionnaires

The methodology may not have been the best for 2 main reasons. People can often skew the truth about their physical activity habits and have poor recall of their physical activity over the past weeks let alone years (especially in the older population).

Which leads us to the next reason, which is time between follow-up assessments and questionnaires. With questionnaires being conducted roughly every 3 years, recall of events can be poor and actual physical activity levels can be very hard to measure accurately, especially when it is exercise minutes per day.

What were the basic results?
The results were that physical activity did decrease the rates of incident of both coronary heart disease and heart failure in men and women. With a lower risk of cardiovascular disease by about 26%, lower risk of coronary heart disease by about 34% and heart failure by about 28%.

Physical activity was also associated with a reduced risk of mortality in both men in women, with a lowered risk of about 28% in men and 19% in women.

They also found that the optimal minutes per day for exercise was between 20-40 minutes, with risk reduction of any cardiovascular event being was most prevalent at 70 years, moderately in 75 years but no significant correlation seen at 80 or 85 years.

Incidents of cardiovascular events were also always lower in the low-increasing and stable-high levels of activity compared to high-decreasing and stable-low.

The researchers assumed that there may be a need for longer exposure to an active lifestyle as significant associations of physical activity with cardiovascular outcomes were only seen in the early in late life (around 70-75) participants.

It appears the researchers don’t over-emphasise their findings as they do not make any outlandish recommendations without the evidence to support it.

What conclusions can we take from this research?
The conclusions that we can take from this research is that physical is very important in our lives. This can be seen with all the decreases in cardiovascular events in the more physically active groups in the research. It is also important to be regularly active as early as possible, as seen with physical activity not having much change in the late elderly population’s cardiovascular events.

This research also aligns with the Australian governments department of health and aged care, recommending 30 minutes of moderate activity per day (within the 20-40 minutes found). Centre for disease control and prevention of the U.S also recommends this amount of time per day.

Practical advice
There are no specific exercise recommendations in this article, however as stated before, between 20-40 minutes of physical activity per day is recommended. However, the exercises undertaken by the participants was recorded in the questionnaires and are as follows.

Moderate exercises conducted in this study were:


 * Walking, bowls, fishing, and other games that require moderate physical activity

Vigorous exercises conducted by the participants were:


 * Gardening, gym, biking, dancing, and swimming

This could be seen as a rough guide or reference of what you can do for exercise.

The main considerations for encouraging physical activity in the elderly population is that it prevents cardiovascular diseases significantly.

Further information/resources
The world health organisation, department of health and aged care, centre of diseases control and prevention are just some examples of organisations that can provide support and helpful guidance for the elderly population. With recommendations for exercise, what exercises are most useful, how often to exercise and useful information for more physically impaired people.