Les cahiers de l'année gérontologique

, Volume 2, Issue 1, pp 59–66

Activité physique et mortalité cardiovasculaire chez le senior

Article de Synthèse / Review Article
  • 59 Downloads

Résumé

De nombreuses études longitudinales ont montré que la pratique régulière d’exercices physiques en endurance est associée à une diminution de la mortalité cardiovasculaire du sujet âgé. L’intensité optimale des exercices demeure débattue, mais certaines études ont objectivé des bénéfices pour des exercices de faible intensité. De tels résultats ont pu être observés pour des activités domestiques ou de loisir, même reprises tardivement dans la vie (après 70 ans). De manière plus objective, les performances cardiorespiratoires maximales, mesurées au cours d’un test d’effort maximal, sont inversement proportionnelles à la mortalité totale et cardiorespiratoire. Dans certains cas, un test d’effort cardiologique doit être proposé aux seniors sédentaires qui souhaitent démarrer des activités physiques (AP) vigoureuses, en particulier chez les diabétiques, en raison d’une augmentation transitoire du risque de syndrome coronarien aigu. Même si les seniors ne respectent pas toujours les recommandations actuelles (30 minutes d’AP par jour), il convient de les encourager régulièrement « à bouger plus », car la pérennisation de la pratique d’exercices physiques demeure fondamentale.

Mots clés

Mortalité cardiovasculaire Activité physique Personne âgée 

Physical activity and cardiovascular mortality among older subjects

Abstract

Many studies have shown that regular physical activity is associated with a reduced cardiovascular mortality among older subjects. The optimal exercise intensity is still matter of debate, although some studies have reported benefits on mortality for low-intensity exercises. Such results are observed for leisure exercises or domestic activity, even if subjects are starting physical activities late in life (after 70 years old). Cardiorespiratory fitness, a most robust and objective measurement obtained during an incremental exercise test has an inverse relationship with cardiovascular mortality among elderly. For older subjects who want to start heavy-intensity exercises, it is necessary to provide a cardiac exercise test, especially for diabetes subjects, because of a transitional increase risk of acute coronary syndrome. Even if older subjects do not respect the current recommendations concerning physical activity practice (at least 30 minutes per day), it is very important to encourage them “to move more” bearing in mind that the promotion of physical activity on the long-term is the cornerstone of exercises health benefits.

Keywords

Cardiovascular mortality Physical activity Older subject 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Références

  1. 1.
    Warburton DE, Nicol CW, Bredin SS (2006) Health benefits of physical activity: the evidence. CMAJ 174:801–9PubMedGoogle Scholar
  2. 2.
    Nocon M, Hiemann T, Müller-Riemenschneider F, et al (2008) Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil 15:239–46CrossRefPubMedGoogle Scholar
  3. 3.
    Physical Activity Guidelines Advisory Committee (2008) Physical activity guidelines advisory committee report. Washington, DC: US Department of Health and Human Services. Site consultable à l’adresse suivante en novembre 2009: www.health.gov/paguidelines/Report/Default.aspxGoogle Scholar
  4. 4.
    Leitzmann MF, Park Y, Blair A, et al (2007) Physical activity recommendations and decreased risk of mortality. Arch Intern Med 167:2453–60CrossRefPubMedGoogle Scholar
  5. 5.
    Hui EK, Rubenstein LZ (2006) Promoting physical activity and exercise in older adults. J Am Med Dir Assoc 7:310–4CrossRefPubMedGoogle Scholar
  6. 6.
    National Center for Chronic Disease Prevention and Health Promotion (2009) Site consultable à l’adresse suivante en novembre: http://www.cdc.gov/nccdphp/sgr/chap5.htm
  7. 7.
    Paffenbarger RS Jr, Hyde RT, Wing AL, Hsieh CC (1986) Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med 314:605–13PubMedCrossRefGoogle Scholar
  8. 8.
    Pekkanen J, Marti B, Nissinen A, et al (1987) Reduction of premature mortality by high-physical activity: a 20-year follow-up of middle-aged Finnish men. Lancet 1:1473–7CrossRefPubMedGoogle Scholar
  9. 9.
    Franco OH, de Laet C, Peeters A, et al (2005) Effects of physical activity on life expectancy with cardiovascular disease. Arch Intern Med 165:2355–60CrossRefPubMedGoogle Scholar
  10. 10.
    Fried LP, Kronmal RA, Newman AB, et al (1998) Risk factors for 5-year mortality in older adults: the Cardiovascular Health Study. JAMA 279:585–92CrossRefPubMedGoogle Scholar
  11. 11.
    Benetos A, Thomas F, Bean KE, et al (2005) Role of modifiable risk factors in life expectancy in the elderly. J Hypertens 23:1803–8CrossRefPubMedGoogle Scholar
  12. 12.
    Yates LB, Djoussé L, Kurth T, et al (2008) Exceptional longevity in men: modifiable factors associated with survival and function to age 90 years. Arch Intern Med 168:284–90CrossRefPubMedGoogle Scholar
  13. 13.
    Lindsted KD, Tonstad S, Kuzma JW (1991) Self-report of physical activity and patterns of mortality in Seven-Day Adventist men. J Clin Epidemiol 44:355–64CrossRefPubMedGoogle Scholar
  14. 14.
    Rosengren A, Wilhelmsen L (1997) Physical activity protects against coronary death and deaths from all causes in middleaged men. Evidence from a 20-year follow-up of the primary prevention study in Göteborg. Ann Epidemiol 7:69–75CrossRefPubMedGoogle Scholar
  15. 15.
    Bijnen FC, Caspersen CJ, Feskens EJ, et al (1998) Physical activity and 10-year mortality from cardiovascular diseases and all causes: The Zutphen Elderly Study. Arch Intern Med 158:1499–505CrossRefPubMedGoogle Scholar
  16. 16.
    Knoops KT, de Groot LC, Kromhout D, et al (2004) Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 292:1433–9CrossRefPubMedGoogle Scholar
  17. 17.
    LaCroix AZ, Leveille SG, Hecht JA, et al (1996) Does walking decrease the risk of cardiovascular disease hospitalizations and death in older adults? J Am Geriatr Soc 44:113–20PubMedGoogle Scholar
  18. 18.
    Wannamethee SG, Shaper AG, Walker M (2000) Physical activity and mortality in older men with diagnosed coronary heart disease. Circulation 102:1358–63PubMedGoogle Scholar
  19. 19.
    Hakim AA, Curb JD, Petrovitch H, et al (1999) Effects of walking on coronary heart disease in elderly men: the Honolulu Heart Program. Circulation 100:9–13PubMedGoogle Scholar
  20. 20.
    Yu S, Yarnell JW, Sweetnam PM, et al (2003) What level of physical activity protects against premature cardiovascular death? The Caerphilly Study. Heart 89:502–6CrossRefPubMedGoogle Scholar
  21. 21.
    Folsom AR, Arnett DK, Hutchinson RG, et al (1997) Physical activity and incidence of coronary heart disease in middle-aged women and men. Med Sci Sports Exerc 29:901–9PubMedGoogle Scholar
  22. 22.
    Morris JN, Everitt MG, Pollard R, et al (1980) Vigorous exercise in leisure-time: protection against coronary heart disease. Lancet 2:1207–10CrossRefPubMedGoogle Scholar
  23. 23.
    Sesso HD, Paffenbarger RS Jr, Lee IM (2000) Physical activity and coronary heart disease in men: The Harvard Alumni Health Study. Circulation 102:975–80PubMedGoogle Scholar
  24. 24.
    Slattery ML, Jacobs DR Jr, Nichaman MZ (1989) Leisure time physical activity and coronary heart disease death. The US Railroad Study. Circulation 79:304–11PubMedGoogle Scholar
  25. 25.
    Manson JE, Greenland P, LaCroix AZ, et al (2002) Walking compared with vigorous exercise for the prevention of cardiovascular events in women. N Engl J Med 347:716–25CrossRefPubMedGoogle Scholar
  26. 26.
    Leon AS, Connett J, Jacobs DR Jr, Rauramaa R (1987) Leisuretime physical activity levels and risk of coronary heart disease and death. The Multiple Risk Factor Intervention Trial. JAMA 258:2388–95CrossRefPubMedGoogle Scholar
  27. 27.
    Leon AS, Connett J (1991) Physical activity and 10.5-year mortality in the Multiple Risk Factor Intervention Trial (MRFIT). Int J Epidemiol 20:690–7CrossRefPubMedGoogle Scholar
  28. 28.
    Kaplan GA, Strawbridge WJ, Cohen RD, Hungerford LR (1996) Natural history of leisure-time physical activity and its correlates: associations with mortality from all causes and cardiovascular disease over 28 years. Am J Epidemiol 144:793–7PubMedGoogle Scholar
  29. 29.
    Besson H, Ekelund U, Brage S, et al (2008) Relationship between sub-domains of total physical activity and mortality. Med Sci Sports Exerc 40:1909–15CrossRefPubMedGoogle Scholar
  30. 30.
    Andersen LB, Schnohr P, Schroll M, Hein HO (2000) All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work. Arch Intern Med 160:1621–8CrossRefPubMedGoogle Scholar
  31. 31.
    Leitzmann MF, Park Y, Blair A, et al (2007) Physical activity recommendations and decreased risk of mortality. Arch Intern Med 167:2453–60CrossRefPubMedGoogle Scholar
  32. 32.
    Gregg EW, Cauley JA, Stone K, et al (2003) Relationship of changes in physical activity and mortality among older women. JAMA 289:2379–86CrossRefPubMedGoogle Scholar
  33. 33.
    Sherman SE, D’Agostino RB, Silbershatz H, Kannel WB (1999) Comparison of past versus recent physical activity in the prevention of premature death and coronary artery disease. Am Heart J 138:900–7CrossRefPubMedGoogle Scholar
  34. 34.
    Wannamethee SG, Shaper AG, Walker M (1998) Changes in physical activity, mortality, and incidence of coronary heart disease in older men. Lancet 351:1603–8CrossRefPubMedGoogle Scholar
  35. 35.
    Stessman J, Hammerman-Rozenberg R, Cohen A, et al (2009) Physical activity, function, and longevity among the very old. Arch Intern Med 169:1476–83CrossRefPubMedGoogle Scholar
  36. 36.
    Byberg L, Melhus H, Gedeborg R, et al (2009) Total mortality after changes in leisure time physical activity in 50 years old men: 35-year follow-up of population-based cohort. BMJ 338:b688CrossRefPubMedGoogle Scholar
  37. 37.
    Blair SN, Kohl HW 3rd, Paffenbarger RS Jr, et al (1989) Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA 262:2395–401CrossRefPubMedGoogle Scholar
  38. 38.
    Sandvik L, Erikssen J, Thaulow E, et al (1993) Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men. N Engl J Med 328:533–7CrossRefPubMedGoogle Scholar
  39. 39.
    Blair SN, Kampert JB, Kohl HW 3rd, et al (1996) Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 276:205–10CrossRefPubMedGoogle Scholar
  40. 40.
    Stevens J, Cai J, Evenson KR, Thomas R (2002) Fitness and fatness as predictors of mortality from all causes and from cardiovascular disease in men and women in the lipid research clinics study. Am J Epidemiol 156:832–41CrossRefPubMedGoogle Scholar
  41. 41.
    Kodama S, Saito K, Tanaka S, et al (2009) Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 301:2024–35CrossRefPubMedGoogle Scholar
  42. 42.
    Batty GD (2002) Physical activity and coronary heart disease in older adults. A systematic review of epidemiological studies. Eur J Public Health 12:171–6CrossRefPubMedGoogle Scholar
  43. 43.
    Mundal R, Erikssen J, Rodahl K (1987) Assessment of physical activity by questionnaire and personal interview with particular reference to fitness and coronary mortality. Eur J Appl Physiol Occup Physiol 56:245–52CrossRefPubMedGoogle Scholar
  44. 44.
    Sui X, LaMonte MJ, Laditka JN, et al (2007) Cardiorespiratory fitness and adiposity as mortality predictors in older adults. JAMA 298:2507–16CrossRefPubMedGoogle Scholar
  45. 45.
    McAuley PA, Myers JN, Abella JP, et al (2007) Exercise capacity and body mass as predictors of mortality among male veterans with type 2 diabetes. Diabetes Care 30:1539–43CrossRefPubMedGoogle Scholar
  46. 46.
    Church TS, LaMonte MJ, Barlow CE, Blair SN (2005) Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes. Arch Intern Med 165:2114–20CrossRefPubMedGoogle Scholar
  47. 47.
    Maclure M (1991) The case-crossover design: a method for studying transient effects on the risk of acute events. Am J Epidemiol 133(2):144–53PubMedGoogle Scholar
  48. 48.
    Mittleman MA, Maclure M, Tofler GH, et al (1993) Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. N Engl J Med 329:1677–83CrossRefPubMedGoogle Scholar
  49. 49.
    Hallqvist J, Möller J, Ahlbom A, et al (2000) Does heavy physical exertion trigger myocardial infarction? A case-crossover analysis nested in a population-based case-referent study. Am J Epidemiol 151:459–67PubMedGoogle Scholar
  50. 50.
    Baylin A, Hernandez-Diaz S, Siles X, et al (2007) Triggers of non-fatal myocardial infarction in Costa Rica: heavy physical exertion, sexual activity, and infection. Ann Epidemiol 17:112–8CrossRefPubMedGoogle Scholar
  51. 51.
    von Klot S, Mittleman MA, Dockery DW, et al (2008) Intensity of physical exertion and triggering of myocardial infarction: a case-crossover study. Eur Heart J 29:1881–8CrossRefGoogle Scholar
  52. 52.
    Shaper AG, Wannamethee G, Weatherall R (1991) Physical activity and ischaemic heart disease in middle-aged British men. Br Heart J 66:384–94CrossRefPubMedGoogle Scholar
  53. 53.
    Sherman SE, D’Agostino RB, Cobb JL, Kannel WB (1994) Does exercise reduce mortality rates in the elderly? Experience from the Framingham Heart Study. Am Heart 128:965–72CrossRefGoogle Scholar
  54. 54.
    Anderson KM, Wilson PW, Odell PM, Kannel WB (1991) An updated coronary risk profile. A statement for health professionals. Circulation 83:356–62PubMedGoogle Scholar
  55. 55.
    Thompson PD, Franklin BA, Balady GJ, et al (2007) Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation 115:2358–68CrossRefPubMedGoogle Scholar
  56. 56.
    Kraus WE, Houmard JA, Duscha BD, et al (2002) Effects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med 347:1483–92CrossRefPubMedGoogle Scholar
  57. 57.
    Ryan AS (2000) Insulin resistance with aging: effects of diet and exercise. Sports Med 30:327–46CrossRefPubMedGoogle Scholar
  58. 58.
    Mozaffarian D, Kamineni A, Carnethon M, et al (2009) Lifestyle risk factors and new-onset diabetes mellitus in older adults: the Cardiovascular Health Study. Arch Intern Med 169:798–807CrossRefPubMedGoogle Scholar
  59. 59.
    Dickinson HO, Mason JM, Nicolson DJ, et al (2006) Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens 24:215–33CrossRefPubMedGoogle Scholar
  60. 60.
    Stewart KJ, Bacher AC, Turner KL, et al (2005) Effect of exercise on blood pressure in older persons: a randomized controlled trial. Arch Intern Med 165:756–62CrossRefPubMedGoogle Scholar
  61. 61.
    Irwin ML, Yasui Y, Ulrich CM, et al (2003) Effect of exercise on total and intra-abdominal body fat in postmenopausal women: a randomized controlled trial. JAMA 289:323–30CrossRefPubMedGoogle Scholar
  62. 62.
    Di Francescomarino S, Sciartilli A, Di Valerio V, et al (2009) The effect of physical exercise on endothelial function. Sports Med 39:797–812CrossRefPubMedGoogle Scholar
  63. 63.
    Pialoux V, Brown AD, Leigh R, et al (2009) Effect of cardiorespiratory fitness on vascular regulation and oxidative stress in postmenopausal women. Hypertension 54:1014–20CrossRefPubMedGoogle Scholar
  64. 64.
    Geffken DF, Cushman M, Burke GL, et al (2001) Association between physical activity and markers of inflammation in a healthy elderly population. Am J Epidemiol 153:242–50CrossRefPubMedGoogle Scholar
  65. 65.
    Franchini M, Lippi G, Favaloro EJ (2009) Coagulopathies and thrombosis: usual and unusual causes and associations, part I. Semin Thromb Hemost 3:257–9CrossRefGoogle Scholar
  66. 66.
    Toraman NF (2005) Short-term and long-term detraining: is there any difference between young-old and old people? Br J Sports Med 39:561–4CrossRefPubMedGoogle Scholar
  67. 67.
    Brechat PH, Lonsdorfer J, Vogel T (2007) Pour une promotion de la santé par des activités physiques et sportives, sûre, personnalisée et accessible pour tous. Presse Med 36:379–80CrossRefPubMedGoogle Scholar
  68. 68.
    Brechat PH, Lonsdorfer J, Vogel T (2006) Consultation de l’aptitude physique du senior pour diminuer les hospitalisations. [Sports medicine for the over-50s: testing and training]. Presse Med 35:268–9CrossRefPubMedGoogle Scholar
  69. 69.
    Vogel T, Bréchat PH, Lepretre PM, et al (2007) Mise en place d’une consultation de l’aptitude physique du senior (CAPS) au pôle de gériatrie du CHRU de Strasbourg. Rev Geriatr 32:431–37Google Scholar
  70. 70.
    Vogel T, Bréchat PH, Lonsdorfer J (2009) Consultation de l’aptitude physique du senior (CAPS) comprenant un programme court de reconditionnement en endurance: le programme d’endurance personnalisé sur cycle (PEP’C). Premiers résultats d’une étude pilote. Sci Sports 24:21–26CrossRefGoogle Scholar
  71. 71.
    Leprêtre PM, Vogel T, Dufour S, et al (2009) Impact of shortterm aerobic interval training on maximal exercise in sedentary aged subjects. Int J Clin Pract 63:1472–8CrossRefPubMedGoogle Scholar
  72. 72.
    Vogel T, Brechat PH, Leprêtre PM, et al (2009) Health benefits of physical activity in older patients: a review. Int J Clin Pract 63:303–20CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2010

Authors and Affiliations

  1. 1.Pôle de gériatriehôpitaux universitaires de Strasbourg, hôpital de La RobertsauStrasbourg cedexFrance
  2. 2.Service de gériatrieCHU de NancyNancyFrance

Personalised recommendations