Endurance exercise training augments diastolic filling at rest and during exercise in healthy young and older men.

Abstract

BACKGROUND Diastolic filling at rest is altered markedly with advancing age. Whether exercise training can improve diastolic filling at rest or during exercise in either healthy older or healthy young men has not been determined. The purpose of this study was to determine if 6 months of aerobic exercise training improves diastolic filling. METHODS AND RESULTS Radionuclide diastolic filling parameters were measured at rest and during exercise in 14 older (age, 60 to 82 years) and 17 young (age, 24 to 32 years) rigorously screened healthy males before exercise training and in 13 older and 11 young men after 6 months of endurance exercise training. Diastolic filling rates were expressed in two ways, as absolute milliliters of blood (mL.s-1.m-2) and normalized to the end-diastolic volume. At baseline, the peak early filling rates were lower in the older group compared with the young group as expressed in absolute milliliters of blood (older, 85 +/- 7 mL.s-1.m-2; young, 173 +/- 10 mL.s-1.m-2; P < or = .0001) and in end-diastolic volume per second (1.66 +/- 0.11 versus 2.55 +/- 0.08, P < .0001), whereas the peak atrial filling rates were greater in absolute milliliters of blood (85 +/- 5 versus 56 +/- 7 mL.s-1.m-2, P = .003) and in end-diastolic volume per second (1.70 +/- 0.12 versus 0.80 +/- 0.06, P < .0001). During exercise, at any given heart rate, the older group had a lower peak filling rate than the young group. Also, at peak exercise, the single peak filling rate was decreased in the older group in mL.s-1.m-2 (384 +/- 19 versus 565 +/- 36 mL.s-1.m-2, P = .0002) and in end-diastolic volume per second (6.01 +/- 0.25 versus 7.91 +/- 0.28 end-diastolic volume per second, P < .0001). Six months of intensive aerobic exercise training had similar effects in the old and young groups overall. Maximal oxygen consumption increased 19% (ANOVA training effect, P < or = .0001) and echocardiographic left ventricular mass increased 8% (ANOVA training effect, P = .002). Training increased the resting peak early filling rate in absolute milliliters of blood by +14% (ANOVA training effect, P = .02). During exercise, the peak early or single peak filling rate at any given heart rate was increased. At peak exercise, the single peak filling rate was increased by 14% in mL.s-1.m-2 (ANOVA training effect, P = .0004). The only age-related differential effect of training was on the peak atrial filling rate in end-diastolic volume per second, which decreased by 27% in the older group but was unchanged in the young (+5%) (ANOVA young versus older, P = .001). The independent predictors of a greater maximal oxygen consumption by multivariate analysis were a higher peak exercise heart rate, a greater resting peak early filling rate, the exercise trained state, and a younger age. CONCLUSIONS Healthy older men have reduced early diastolic filling at rest and during exercise compared with young men. Endurance exercise training enhances early diastolic filling at rest and during exercise in both the old and the young. Training reduces the elevated resting atrial filling rate in the old, whereas the young were unchanged. The training-induced augmentation of early diastolic filling at rest and during exercise may be an important adaptation to allow an increase in stroke volume at rest and an increase in stroke volume, cardiac output, and maximal oxygen consumption during exercise.

The impact of endurance exercise training on left ventricular systolic mechanics

“…We did, however, observe significant increases in LV end-diastolic volume following EET. In absence of an explanatory rise in left atrial pressure, this increase is most likely due to the eccentric LV hypertrophy with an enhancement of diastolic function, which accompanies EET as previously reported (3,23,46). EET enhancement of diastolic function with resultant increases in LV end-diastolic volume has the potential to increase LV preload and thus affect LV systolic function.…”

“…Increases in LV chamber dimensions, wall thickness, and mass have been documented among individuals who participate in EET, and it is these structural attributes that underlie the concept of the "athlete's heart" (8,38,41). At the present time, the impact of EET on LV functional mechanics is less clear.Several reports demonstrate that EET results in enhanced LV diastolic function (3,23,31). In contrast, existing data suggest that LV systolic function is unchanged by EET (9,15,39).…”

“…Several reports demonstrate that EET results in enhanced LV diastolic function (3,23,31). In contrast, existing data suggest that LV systolic function is unchanged by EET (9,15,39).…”

Exercise-training-induced changes in metabolic capacity with age: the role of central cardiovascular plasticity

“…Specifically, the SV training response in moderately active old subjects has been suggested to rely on cardiac dilatation whereas, in contrast, the improvements in young people are explained by an increased ejection fraction (Stratton et al 1994). However, these findings may again be blurred both by initial VO 2max and Q max values, as ejection fraction and ventricular function can be enhanced in older endurance trained men (Seals et al 1994), and to adapt following aerobic training with sufficient intensity Levy et al 1993). …”

Effects of Exercise and Lifestyle Intervention on Cardiovascular Function in CKD

“…Therefore, resting LV filling pressure is increased and LV contractility is enhanced in CKD in order to maintain E A /E LV and cardiac performance (11). Unfit individuals have less favorable cardiac filling profiles at rest than active participants (12), and exercise training can elicit positive changes in diastolic (13) and vascular function (14) in patients with existing CVD.…”