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The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Advance Access published online on October 12, 2009
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, doi:10.1093/gerona/glp147
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© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Relationships of Cardiac, Pulmonary, and Muscle Reserves and Frailty to Exercise Capacity in Older Women

Carlos O. Weiss1,2, Helen H. Hoenig3,4, Ravi Varadhan2,5, Eleanor M. Simonsick1,6 and Linda P. Fried7

1 Division of Geriatric Medicine & Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
2 Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
3 Department of Medicine, Division of Geriatrics, Duke University Medical Center, Durham, North Carolina
4 Physical Medicine & Rehabilitation Service, Durham Veterans Administration Medical Center, North Carolina
5 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
6 Clinical Research Branch, National Institute on Aging, Baltimore, Maryland
7 Mailman School of Public Health, Columbia University, New York, New York

Address correspondence to Carlos O. Weiss, MD, MHS, Division of Geriatric Medicine and Gerontology, 5200 Eastern Avenue, Mason F. Lord Center Tower No. 711, Baltimore, MD 21224-2734. Email: cweiss9{at}jhmi.edu


  Abstract

Background: A decline in exercise capacity (EC) is a characteristic of frality. 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.

Keywords Frailty; Exercise capacity

Received: April 2, 2008; Accepted: September 2, 2009

Decision Editor: Luigi Ferrucci, MD, PhD


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