Physical activity and cardiovascular aging: Physiological and molecular insights

Aging is associated with significant changes in both cardiac and vascular structure and function that lower the threshold for clinical signs and symptoms, making older people more susceptible to cardiovascular diseases, morbidity and mortality. Understanding of age-related cardiovascular changes is necessary for effective and efficient prevention and treatment of cardiovascular disease in older people. Cardiac aging is associated with left ventricular remodelling marked by increased mass-to-volume ratio and accompanied by systolic and diastolic myocardial dysfunction, and reduced sensitivity to sympathetic stimuli that compromises myocardial contractility and pumping ability in older people. The vascular age-related remodelling is associated with increased arterial wall thickness, arterial stiffness, and an impaired endothelial vasoreactivity. Over the previous three decades of intensive research in cardiovascular aging, it became apparently clear that lifestyle factors such as physical activity and exercise play an important role in attenuating cardiovascular function decline with aging. This review highlights the effect of age on cardiac and vascular changes and their adaptations to exercise, providing physiological, molecular and cellular mechanisms that underlie diminished cardiovascular response in older age. It further describes cardiovascular differences between the individuals who maintain a physically active lifestyle, and who undergo exercise interventions in later life.