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Circulation, Vol 88, 116-126, Copyright © 1993 by American Heart Association
WC Levy, MD Cerqueira, IB Abrass, RS Schwartz and JR Stratton
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.
ARTICLES
Endurance exercise training augments diastolic filling at rest and during exercise in healthy young and older men
Division of Cardiology, Seattle Veterans Affairs Medical Center, Wash.
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