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(Circulation. 2005;112:674-682.)
© 2005 American Heart Association, Inc.

Exercise Physiology

Accelerated Longitudinal Decline of Aerobic Capacity in Healthy Older Adults

Jerome L. Fleg, MD; Christopher H. Morrell, PhD; Angelo G. Bos, MD, PhD; Larry J. Brant, PhD; Laura A. Talbot, RN, PhD; Jeanette G. Wright; Edward G. Lakatta, MD

From the Laboratory of Cardiovascular Science (J.L.F., C.H.M., J.G.W., E.G.L.) and Laboratory of Clinical Investigation (A.G.B.) and Research Resources Branch (L.J.B.), Gerontology Research Center, National Institute on Aging, National Institutes of Health, Baltimore, Md; the Mathematical Sciences Department, Loyola College in Maryland, Baltimore, Md (C.H.M.); and the Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Md (L.A.T.).

Correspondence to Jerome L. Fleg, MD, National Heart, Lung, and Blood Institute, 6701 Rockledge Dr, Room 8112, Bethesda, MD 20892-7936. E-mail flegj{at}nhlbi.nih.gov

Received February 24, 2005; revision received March 18, 2005; accepted April 1, 2005.

Background— The ability of older persons to function independently is dependent largely on the maintenance of sufficient aerobic capacity and strength to perform daily activities. Although peak aerobic capacity is widely recognized to decline with age, its rate of decline has been estimated primarily from cross-sectional studies that may provide misleading, overly optimistic estimates of aging changes.

Methods and Results— To determine longitudinal rate of change in aerobic capacity and the influence of age, gender, and physical activity on these changes, we performed serial measurements of peak treadmill oxygen consumption (peak O₂) in 375 women and 435 men ages 21 to 87 years from the Baltimore Longitudinal Study of Aging, a community-dwelling cohort free of clinical heart disease, over a median follow-up period of 7.9 years. A linear mixed-effects regression model was used to calculate the predicted longitudinal 10-year rate of change in peak O₂, expressed in milliliters per minute, for each age decade from the 20s through the 70s after adjustment for self-reported leisure-time physical activity. A longitudinal decline in peak O₂ was observed in each of the 6 age decades in both sexes; however, the rate of decline accelerated from 3% to 6% per 10 years in the 20s and 30s to >20% per 10 years in the 70s and beyond. The rate of decline for each decade was larger in men than in women from the 40s onward. Similar longitudinal rates of decline prevailed when peak O₂ was indexed per kilogram of body weight or per kilogram of fat-free mass and in all quartiles of self-reported leisure-time physical activity. When the components of peak O₂ were examined, the rate of longitudinal decline of the oxygen pulse (ie, the O₂ utilization per heart beat) mirrored that of peak O₂, whereas the longitudinal rate of heart rate decline averaged only 4% to 6% per 10 years, and accelerated only minimally with age.

Conclusions— The longitudinal rate of decline in peak O₂ in healthy adults is not constant across the age span in healthy persons, as assumed by cross-sectional studies, but accelerates markedly with each successive age decade, especially in men, regardless of physical activity habits. The accelerated rate of decline of peak aerobic capacity has substantial implications with regard to functional independence and quality of life, not only in healthy older persons, but particularly when disease-related deficits are superimposed.

Key Words: aging • exercise • follow-up studies

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