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Comparative Study
. 2010 Mar;65(3):287-94.
doi: 10.1093/gerona/glp147. Epub 2009 Oct 12.

Relationships of cardiac, pulmonary, and muscle reserves and frailty to exercise capacity in older women

Carlos O Weiss  1 , Helen H Hoenig, Ravi Varadhan, Eleanor M Simonsick, Linda P Fried
Affiliations
Comparative Study

Relationships of cardiac, pulmonary, and muscle reserves and frailty to exercise capacity in older women

Carlos O Weiss et al. J Gerontol A Biol Sci Med Sci. 2010 Mar.

Abstract

Background: A decline in exercise capacity (EC) is a characteristic of frailty. We hypothesized that decline is the effect of decrements in several physiological systems. We assessed whether the relationship of three main physiological systems-cardiac, pulmonary, and musculoskeletal-to EC is independent or interactive and whether their effect on EC varies with respect to frailty status.

Methods: Observational study of 547 disabled women aged 65 years and older (Women's Health and Aging Study I) including 131 frail who participated in a test of EC. EC (seated step test), cardiac function (chronotropic index), pulmonary function (forced vital capacity, FVC), musculoskeletal function (quadriceps strength, QS), and frailty status were measured and interactive effects were modeled using linear regression and differentiation.

Results: Each physiological system had a direct relationship with EC, which was lower in frail compared with nonfrail. The relationship between FVC and EC was positive and increased with increasing QS in nonfrail subjects. The effect of QS on EC was positive and increased with increasing FVC regardless of frailty. In subjects with low QS, frailty status was associated with lower EC and this effect became stronger with increasing FVC. Discussion Findings suggest but do not show that frailty status modifies the effects of physiological function in several systems on EC. Approaches to understanding emergent properties such as vulnerability to illness and death and clinical efforts to prevent and treat frailty should evaluate and possibly intervene on several physiological systems to be maximally effective.

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Figures

Figure 1.
Figure 1.
Propensity to be frail, according to participation in the seated step test of exercise capacity.
Figure 2.
Figure 2.
Distribution of exercise capacity (minutes of seated step test completed) according to frailty status in moderately to severely disabled older women.
Figure 3.
Figure 3.
Associations of chronotropic index (CI), forced vital capacity (FVC) and quadriceps strength (QS) with Exercise Capacity, according to frailty status.
Figure 4.
Figure 4.
(A–C) Effects calculated from interactive model using the differentiation approach described by Kam and Franzese (19). The y-axis represents the effect of one parameter on exercise capacity. The effect is displayed across clinically meaningful values (10th–90th percentiles for continuous variables) of the other parameters.
See this image and copyright information in PMC

Comment in

  • Understanding frailty.
    Bortz W. Bortz W. J Gerontol A Biol Sci Med Sci. 2010 Mar;65(3):255-6; discussion 257. doi: 10.1093/gerona/glp162. Epub 2009 Nov 3. J Gerontol A Biol Sci Med Sci. 2010. PMID: 19887535 No abstract available.

References

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