Physical activity in the prevention of peripheral artery disease in the elderly

Abstract

Aging is a well-known cardiovascular risk factor and cardiovascular diseases (CVD) are estimated to be the most common cause of death in the elderly. Peripheral arterial disease (PAD) represents an important clinical manifestation of CVD leading to increase morbidity and mortality, especially in elderly population. The correct management of PAD population includes the prevention of cardiovascular events and relief of symptoms, most commonly intermittent claudication. Progressive physical activity is an effective treatment to improve walking distance and to reduce mortality and cardiovascular events in patients with PAD, however the ability to effectively engage in physical activity often declines with increasing age. The maintenance and increase of reserve functional capacity are important concepts in the elderly population. Ultimately, the goal in participation of physical activity in the healthy elderly population is maintenance and development of physical functional reserve capacity. Therefore, for individuals suffering of PAD, appropriate physical activity in the form of supervised exercise may serve as a primary therapy. Although there are few direct comparisons of therapeutic exercise programs vs. pharmacological or surgical interventions, these increases in walking distance are greater than those reported for the most widely used agents for claudication, pentoxyphylline, and cilostazol. Despite a reduction in mortality and improvement of quality of life caused by physical activity in the PAD population, the molecular, cellular, and functional changes that occur during physical activity are not completely understood. Therefore, this review article aims at presenting an overview of recent established clinical and molecular findings addressing the role of physical activity on PAD in the older population.

Aging in blood vessels. Medicinal agents FOR systemic arterial hypertension in the elderly

“…So far, there are no genetic or molecular solutions to slow the progression of cardiovascular aging. Exercise decreases the progression of arterial stiffness and improves endothelial function in skeletal muscle (Vita and Keaney, 2000) promoting vasodilatation (Schiattarella et al, 2014). Exercise also lowers blood pressure and heart rate, thereby decreasing arterial wall distention, improves ejection volume and slows myocardial remodeling (Schiattarella et al, 2014).…”

“…Also the oxidative response determines the rate of VSMC proliferation (Moon et al, 2001). It has also been proposed that an increase in the sympathetic autonomous nervous system tone activity toward the vessels might play an important role in renovation and proliferation of the muscle (Schiattarella et al, 2014).…”

“…Exercise decreases the progression of arterial stiffness and improves endothelial function in skeletal muscle (Vita and Keaney, 2000) promoting vasodilatation (Schiattarella et al, 2014). Exercise also lowers blood pressure and heart rate, thereby decreasing arterial wall distention, improves ejection volume and slows myocardial remodeling (Schiattarella et al, 2014). Vasodilator drugs such as ACEi or AT1-blockers and calcium channel blockers (Ting et al, 1993(Ting et al, , 1995 reduce pulse wave reflection and thus the pressure pulse and they protect muscular arteries from endothelial dysfunction (Armentano et al, 2006) These drugs prevent ventricular remodeling due to pressure overload in hypertension and it is likely that they could also protect from overload during aging.…”

Outcomes after non-cardiac surgery: mortality, complications, disability, and rehospitalization

“…Frailty is defined as a clinical condition characterized by the presence of a state of reduced physiological reserve and a greater vulnerability to stressors. In the elderly patient, frailty is significantly associated to an increased risk of adverse events, functional decline, procedural complications, prolonged hospitalization and mortality [1]. The correlation between frailty and the increase in mortality and morbidity necessitates an appropriate assessment tool to accurately quantify the clinical and perioperative condition of the patient [2].…”

Utilization of Oxidative Stress Biomarkers Is Important to Assess Treatment Effects on Exercise Capacity in Patients With Intermittent Claudication

“…11 To date, exercise therapy has been considered to play a key role in the management of patients with IC, as it significantly improves the pain-free walking distance and absolute walking distance and lowers the risk of CVD. 12 Moreover, among the exercise therapies available, supervised exercise therapy (SET), which is programmed training under the supervision of trained physiotherapists or doctors, has been demonstrated to provide better results than non-interventional exercise.…”