posted on 01/09/2022 06:00
(credit: American Heart Association/Disclosure)
Smoking, hypertension and high cholesterol are known triggers of cardiovascular disease. However, regardless of these variables, poor performance in tasks that require physical skills is a risk factor for heart attack, heart failure and stroke in the elderly. A new study has found that people over age 65 who do poorly on a test combining walking speed, balance and sitting and standing strength are more likely to suffer from these problems. That, even if they don’t smoke, control their blood pressure and adopt a healthy diet.
Published in the Journal of the American Heart Association, the study was conducted with more than 5,500 people aged 75 on average. The researchers’ interest was to assess the relationship of cardiovascular health to physical function, which is not the same as fitness. While the latter refers to performance in sports activities, the former is related to the ability to perform day-to-day actions, such as getting up alone, not having balance problems and walking without difficulty.
To this end, researchers at the Johns Hopkins Bloomberg School of Public Health, in the United States, used a battery of tests that evaluated these three variables. “We found that physical function in older adults predicts future cardiovascular disease in addition to traditional risk factors for heart disease, regardless of whether an individual has a history of cardiovascular disease,” said study senior author Kunihiro Matsushita, associate professor in the department. of epidemiology of the institution.
The test applied among the participants measured physical function to produce a score according to walking speed, speed of standing up from a chair without using hands and standing balance. Participants were categorized according to performance: low, intermediate and high. Among all volunteers, 13% fit into the first group; 30% in the second, and 57% in the last.
All participants were followed for eight years, during which time 930 were diagnosed with one or more cardiovascular events — 86 had a heart attack, 251 had a stroke, and 529 developed heart failure. The researchers then examined the association of test scores with these occurrences. To check for the specific participation of physical function, they adjusted for major risk factors for diseases that affect the heart and vascular system, such as high blood pressure, smoking, high cholesterol, diabetes, and family history.
The results showed that, compared to adults with high physical function scores, those with the worst scores were 47% more likely to have at least one type of cardiovascular disease. Those in the intermediate category had a 25% higher risk. “The association between physical function and cardiovascular disease remained after controlling for traditional cardiovascular disease risk factors,” said the study’s lead author, epidemiologist Xiao Hu, in a note. “Our findings highlight the value of assessing the level of physical function of older adults in clinical practice. In addition to heart health, older adults are at increased risk for falls and disabilities. Assessment of physical function can also inform the risk of these conditions in older adults. “
Cardiologist Carlos Rassi, professor at the University of Brasília (UnB) and head of emergency care at Hospital Sírio-Libanês de Brasília, says that, due to evidence that the practice of physical activity – essential for the maintenance of daily functions – reduces mortality, many doctors already make this assessment. “The exercise test does not measure balance and trunk strength (sitting and standing up without help), but shows the speed when walking. In the case of the most frail elderly, we can do a six-minute walk test”, he notes.
According to Kunihiro Matsushita, from Johns Hopkins, it is now necessary to investigate which interventions are most appropriate to improve physical function and reduce the risk of cardiovascular diseases, including with people who have limitations. Carlos Rassi recalls that previous studies have shown that even lighter physical activities, such as walking 10 minutes a day, increase longevity, potentially reducing the risk of various diseases. “You can start with five minutes of daily walking and three months later increase to 10, for example. The important thing is not to stand still”, he teaches.
Two questions for…
Milton Henriques Guimarães Júnior, cardiologist at the São Francisco Xavier Foundation, in Minas Gerais
Should physical function be evaluated in the elderly as a risk factor for cardiovascular disease?
Yup. The study published in the Journal of the American Heart Association made a correlation between the degree of physical activity and the occurrence of cardiovascular events, such as myocardial infarction, stroke or development of heart failure. Elderly people who performed better in the physical assessment had fewer events. This classification based on physical capacity was complementary and had an incremental power in relation to the risk factors that we already know (high cholesterol, high blood pressure, diabetes). Therefore, we must consider the physical capacity of the elderly as a factor capable of predicting the occurrence of cardiovascular disease.
What are the best strategies for improving physical function aimed at the elderly, who often have limitations that prevent the rigorous practice of physical exercises?
An individualized assessment is very important. Seniors are not the same. Each one has a different profile: some have concomitant orthopedic, neurological or cardiovascular diseases, which require a prior specialized evaluation before the release and prescription of physical activity. Therefore, the recommendation is a multiprofessional evaluation, with a physician and a physical therapist, in order to evaluate, release and monitor the beginning of physical activity in the elderly.