Message to older adults: embrace, don't fear the effects of sensible exercise

Stress from exercise does not threaten the heart, Hopkins study shows

A Johns Hopkins study should ease the concerns held by many older adults with mild high blood pressure about the strain or harm exercise could cause their hearts. Results of the research on 104 men and women age 55 to 75 showed that a moderate program of physical exertion had no ill effects on the heart's ability to pump blood nor does it produce a harmful increase in heart size.

In this study, "moderate" translated to sustained exercise for about an hour, three times a week. Researchers say that people's concerns stem from the fact that during each workout, blood pressure can on average rise from 40 millimeters to 60 millimeters of mercury. The Hopkins study is believed to be the first to evaluate the effects of exercise on the heart's ability to function, to pump and to fill up with blood.

"While having high blood pressure at rest is a well-established risk factor for heart problems, older people should not fear the effects of moderate exercise on the heart, despite short-term bump-ups in blood pressure during their workout," says lead study investigator and exercise physiologist Kerry Stewart, Ed.D., a professor of medicine and director of clinical and research exercise physiology at The Johns Hopkins University School of Medicine and its Heart Institute. "Exercise is a highly effective means of increasing the heart's efficiency and reducing body fat, factors that may ward off future health problems, such as heart disease and diabetes."

A report on the Hopkins study, published in the July issue of the journal Heart, showed that after six months of aerobic exercise on a treadmill, bicycle or stepper, plus weightlifting, participants showed no overall ill effects in 11 measures of diastolic heart function, when the organ's main chamber fills with blood between beats. They also found that exercise produced no increase in eight measures of heart size, including left ventricular mass and wall thickness. In contrast, a long-term effect of hypertension, even when the body is relaxed, is hypertrophy, an enlargement of the heart that eventually stiffens and weakens the muscle.

Not only were there no ill effects sustained, despite periodic increases in blood pressure during the workout, Stewart and his team reported, but results also suggest that the exercise producing these effects benefited the hearts of those who made the most gains in physical fitness and for those who lost the most abdominal fat.

Researchers found, for example, that each single point gain in aerobic fitness (of 1 milliliter per kilogram per minute), as measured by peak oxygen uptake by the blood during exercise, translated to a 1.5 percent improvement in one key measure (the E/A ratio), used to measure diastolic heart function. In addition, every 10-point decrease in abdominal fat (of 1 square centimeter) translated to a 1.2 percent gain in a second key measure (the Em/Am ratio).

And, researchers say, unlike the increased heart size that results from high blood pressure, any increase in heart size observed in the active group was similar to what athletes experience when their hearts get bigger and stronger, not stiff.

They describe the activity-related form as physiological hypertrophy as opposed to the former kind, which they call pathological hypertrophy.

For a six-month period, the Hopkins team assessed the benefits of a supervised program of exercise training in a group of 104 older men and women, measuring heart function, and body fitness and fat levels at the start and end of the study. All of the participants were in general good health except for untreated, mild hypertension. Half were randomly placed in a widely recommended moderate exercise program while the rest maintained their usual physical routine and diet.

The active group participated in a supervised series of exercises for 60 minutes, three times per week. The combination of exercises was designed to work all major muscle groups, including the heart, with substantial improvements observed in active participants' body fat, and muscle and fitness levels.

Aerobic fitness, as measured by peak oxygen uptake on a treadmill, increased by 17 percent (from 24.4 milliliters per kilogram per minute to 28.4 milliliters per kilogram per minute), as did average strength (from an estimated ability to lift a total of 383 kilograms from 328 kilograms, using seven different weight machines). The average weight loss in this group was only four pounds, because much of the loss of fat was offset by increased muscle mass. The fat in the abdominal region, measured by magnetic resonance imaging, was reduced by 20 percent among exercisers. The group that was not exercising had either no or significantly less improvement than the exercising group. Special scans, using an X-ray machine, were used to assess total body fat.

"Making gains in body fitness and losing abdominal fat are truly important to the long-term health of the heart," says study co-author and cardiologist Edward Shapiro, M.D., a professor at Hopkins. "Our results confirm that moderate-intensity exercise can have many health benefits - including gains in heart function that are linked to increased fitness and reduced fatness.

"Our study also shows that the vast majority of older people with mildly elevated blood pressure can benefit from moderate exercise, and they should talk about it with their physician to determine an appropriate exercise and any other options for treatment."

The Hopkins study's exercise program followed current guidelines from the American College of Sports Medicine. The study was part of a larger, ongoing trial, called the Senior Hypertension and Physical Exercise study (or SHAPE, for short). It is believed to be the first detailed examination of the guidelines' effectiveness and the separate effects of exercise on blood pressure, heart structure and cardiovascular function, with nearly an equal number of men and women enrolled.

A study published last year by the Hopkins scientists showed that exercise reduced by more than 20 percent the number of people who develop metabolic syndrome, a clustering of three or more risk factors for developing heart disease, diabetes and stroke. Risk factors include high blood pressure, elevated blood glucose levels, excess abdominal fat and abnormal cholesterol.

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Funding for the study was provided by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH), with additional assistance from the Johns Hopkins Bayview General Clinical Research Center, also funded by the NIH. Besides Stewart and Shapiro, other Hopkins researchers who took part in this study were Pamela Ouyang, M.D.; Anita Bacher, M.S.N., M.P.H.; and Sandra Lima.

On the Web: http://heart.bmjjournals.com/cgi/content/full/92/7/893


Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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