Cardiovascular Considerations in the Older Patient: Difference between revisions

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=== Causes of changes in heart rate  ===
=== Causes of changes in heart rate  ===


The reduction in maximal heart rate is thought to be due to changes in the autonomic nervous system<ref>Heckman GA, McKelvie RS: Cardiovascular aging and exercise in healthy older adults. Clin J Sport Med 18:479-485, 2008</ref><ref>Brown SP, Miller WC, Eason JM: Exercise physiology: basis of human movement and disease, Baltimore, MD, 2006, Lippincott Williams &amp;amp; Wilkins</ref>  
The reduction in maximal heart rate is thought to be due to changes in the autonomic nervous system<ref>Heckman GA, McKelvie RS: Cardiovascular aging and exercise in healthy older adults. Clin J Sport Med 18:479-485, 2008</ref><ref>Brown SP, Miller WC, Eason JM: Exercise physiology: basis of human movement and disease, Baltimore, MD, 2006, Lippincott Williams &amp;amp;amp; Wilkins</ref>, along with age-related decrease in the number of cells in the sinoatrial node.


=== Consequences of reduction in maximum heart rate  ===
=== Consequences of reduction in maximum heart rate  ===
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<br>  
<br>  


== Changes in vascular tissues ==
== Changes in vascular tissues ==


=== Stiffer vascular tissues ===
=== Stiffer vascular tissues ===


Changes in connective tissue as we age include:
Changes in connective tissue as we age include:  


increased crosslinking of collagen
increased crosslinking of collagen  


loss of elastin
loss of elastin  


thickening of the basement membrane in the capillary walls<ref>Vaitkevicius PV, Fleg JL, Engel JH, et al: Effects of age and aerobic capacity on arterial stiffness in healthy adults. Circulation 88(4 Pt 1):1456–1462, 1993</ref>
thickening of the basement membrane in the capillary walls<ref>Vaitkevicius PV, Fleg JL, Engel JH, et al: Effects of age and aerobic capacity on arterial stiffness in healthy adults. Circulation 88(4 Pt 1):1456–1462, 1993</ref>  


These result in the heart and blood vessels being stiffer and less compliant<ref>Franzoni F, Galetta F, Morizzo C, et al: Effects of age and physical fitness on microcirculatory function. Clin Sci (Lond) 106(3):329–335, 2004</ref>, and this in turn leads to increased blood pressure<ref>Kasch FW, Boyer JL, Van Camp S, et al: Cardiovascular changes with age and exercise. A 28–year longitudinal study. Scand J Med Sci Sports 5(3):147–151, 1995</ref><ref>Ferreira I, Twisk JW, Stehouwer CD, et al: Longitudinal changes in VO2max: associations with carotid IMT and arterial stiffness. Med Sci Sports Exerc 35(10):1670–1678, 200</ref>;
These result in the heart and blood vessels being stiffer and less compliant<ref>Franzoni F, Galetta F, Morizzo C, et al: Effects of age and physical fitness on microcirculatory function. Clin Sci (Lond) 106(3):329–335, 2004</ref>, and this in turn leads to increased blood pressure<ref>Kasch FW, Boyer JL, Van Camp S, et al: Cardiovascular changes with age and exercise. A 28–year longitudinal study. Scand J Med Sci Sports 5(3):147–151, 1995</ref><ref>Ferreira I, Twisk JW, Stehouwer CD, et al: Longitudinal changes in VO2max: associations with carotid IMT and arterial stiffness. Med Sci Sports Exerc 35(10):1670–1678, 200</ref>;  


it is noticeable that the majority of patients who 70 years of age or older are likely to be taking antihypertensive medication.
it is noticeable that the majority of patients who 70 years of age or older are likely to be taking antihypertensive medication.  


The thickening in the basement membrane of the capillary walls means that the delivery of oxygen and nutrients is slower than in younger people, although there is some evidence to suggest that this effect is modifiable with high levels of exercise<ref>Schroeder TE, Hawkins SA, Hyslop D, et al: Longitudinal change in coronary heart disease risk factors in older runners. Age Ageing 36(1):57–62, 2007</ref>
The thickening in the basement membrane of the capillary walls means that the delivery of oxygen and nutrients is slower than in younger people, although there is some evidence to suggest that this effect is modifiable with high levels of exercise<ref>Schroeder TE, Hawkins SA, Hyslop D, et al: Longitudinal change in coronary heart disease risk factors in older runners. Age Ageing 36(1):57–62, 2007</ref>.


=== Reduction in contractitility of vascular walls ===
=== Reduction in contractitility of vascular walls ===
<div>This contributes to slowing of heart rate, lower VO2max and results in a reduction in the aerobic workload possible.</div>
== Challenges for physiotherapy management ==


Despite the fact that maximum heart rate and aerobic capacity are reduced, exercise in healthy older adults has been demonstrated in many studies to be effective in improving cardiac function and increasing aerobic capacity<ref>Leicht AS, Allen GD, Hoey AJ: Influence of age and moderate-intensity exercise training on heart rate variability in young and mature adults. Can J Appl Physiol 28(3):446–461, 2003</ref><ref>Ogawa T, Spina RJ, Martin WH 3rd, et al: Effects of aging, sex, and physical training on cardiovascular responses to exercise. Circulation 86(2):494–503, 1992</ref><ref>Kohrt WM, Malley MT, Coggan AR, et al: Effects of gender, age, and fitness level on response of VO2max to training in 60–71 yr olds. J Appl Physiol 71(5):2004–2011, 1991</ref>.


The further reading section of the page on [[Physical_Activity_and_Older_Adults|Physical Activity and Older Adults]]&nbsp;has links to some useful resources.


== Sub Heading 3  ==
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) ==
 
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) ==
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Revision as of 00:10, 24 June 2014

Original Editor - Wendy Walker

Top Contributors - Kim Jackson, Lucinda hampton, Wendy Walker, Andeela Hafeez, Esraa Mohamed Abdullzaher, WikiSysop, Fasuba Ayobami, 127.0.0.1, Evan Thomas, Vidya Acharya and Lauren Lopez  

Changes in Heart Rate[edit | edit source]

As we age, one of the most notable changes in the cardiac system is the decline in maximal heart rate.
  • One of the common means of establishing a guideline for change in maximal heart rate is the following formula[1]:
220 - age = max heart rate
Therefore whereas a young adult of 20 can be expected to have a maximal heart rate of 200 bpm (beats per minute), in a 70 year old this will be only 150 bpm, in an 80 year old 140bpm and in a 90 year old 130 bpm.

Causes of changes in heart rate[edit | edit source]

The reduction in maximal heart rate is thought to be due to changes in the autonomic nervous system[2][3], along with age-related decrease in the number of cells in the sinoatrial node.

Consequences of reduction in maximum heart rate[edit | edit source]

  • Smaller aerobic workload possible - ie. reduction in the extent of cardiac exertion that can be tolerated for a period of time
  • Slower aerobic performance - eg. 90 year olds completing the New York City marathon typically do so in 7-8 hours


Changes in vascular tissues[edit | edit source]

Stiffer vascular tissues[edit | edit source]

Changes in connective tissue as we age include:

increased crosslinking of collagen

loss of elastin

thickening of the basement membrane in the capillary walls[4]

These result in the heart and blood vessels being stiffer and less compliant[5], and this in turn leads to increased blood pressure[6][7];

it is noticeable that the majority of patients who 70 years of age or older are likely to be taking antihypertensive medication.

The thickening in the basement membrane of the capillary walls means that the delivery of oxygen and nutrients is slower than in younger people, although there is some evidence to suggest that this effect is modifiable with high levels of exercise[8].

Reduction in contractitility of vascular walls[edit | edit source]

This contributes to slowing of heart rate, lower VO2max and results in a reduction in the aerobic workload possible.

Challenges for physiotherapy management[edit | edit source]

Despite the fact that maximum heart rate and aerobic capacity are reduced, exercise in healthy older adults has been demonstrated in many studies to be effective in improving cardiac function and increasing aerobic capacity[9][10][11].

The further reading section of the page on Physical Activity and Older Adults has links to some useful resources.

Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

References will automatically be added here, see adding references tutorial.

  1. ↑ Ehrman JK, Gordon PM, Visich PS, Keteyian SJ: Clinical exercise physiology, Champaign, IL, 2009, Human Kinetics
  2. ↑ Heckman GA, McKelvie RS: Cardiovascular aging and exercise in healthy older adults. Clin J Sport Med 18:479-485, 2008
  3. ↑ Brown SP, Miller WC, Eason JM: Exercise physiology: basis of human movement and disease, Baltimore, MD, 2006, Lippincott Williams &amp;amp; Wilkins
  4. ↑ Vaitkevicius PV, Fleg JL, Engel JH, et al: Effects of age and aerobic capacity on arterial stiffness in healthy adults. Circulation 88(4 Pt 1):1456–1462, 1993
  5. ↑ Franzoni F, Galetta F, Morizzo C, et al: Effects of age and physical fitness on microcirculatory function. Clin Sci (Lond) 106(3):329–335, 2004
  6. ↑ Kasch FW, Boyer JL, Van Camp S, et al: Cardiovascular changes with age and exercise. A 28–year longitudinal study. Scand J Med Sci Sports 5(3):147–151, 1995
  7. ↑ Ferreira I, Twisk JW, Stehouwer CD, et al: Longitudinal changes in VO2max: associations with carotid IMT and arterial stiffness. Med Sci Sports Exerc 35(10):1670–1678, 200
  8. ↑ Schroeder TE, Hawkins SA, Hyslop D, et al: Longitudinal change in coronary heart disease risk factors in older runners. Age Ageing 36(1):57–62, 2007
  9. ↑ Leicht AS, Allen GD, Hoey AJ: Influence of age and moderate-intensity exercise training on heart rate variability in young and mature adults. Can J Appl Physiol 28(3):446–461, 2003
  10. ↑ Ogawa T, Spina RJ, Martin WH 3rd, et al: Effects of aging, sex, and physical training on cardiovascular responses to exercise. Circulation 86(2):494–503, 1992
  11. ↑ Kohrt WM, Malley MT, Coggan AR, et al: Effects of gender, age, and fitness level on response of VO2max to training in 60–71 yr olds. J Appl Physiol 71(5):2004–2011, 1991

 

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