Effects of silent myocardial ischemia on functional fitness and physical independence in 60-79-year-old adults

Abstract

Objective

Conclusion

Keywords

Older adults / Silent myocardial ischemia / Functional fitness / Physical independence

We examined the effect of silent myocardial ischemia (SMI) on functional fitness levels and physical independence in 60-79-year-old individuals.

Methods

We conducted a cross-sectional study with 716 older adults and used an electrocardiograph and an ambulatory electrocardiogram to diagnose those with SMI. Physical independence was assessed using the Composite Physical Function scale, whereas physical fitness was assessed using the Senior Fitness Test battery.

Results

The 60-79-year-old females and males with SMI were more likely to have lower scores for lower and upper body strength, agility/dynamic balance, and aerobic endurance (p < 0.05) than those without SMI. The scores for lower and upper body flexibility in all age groups for both genders were not significant (p > 0.05). Binary logistic regression analysis revealed that old adults with SMI had a higher risk of losing physical independence later in life than those without SMI (p < 0.05).

This study showed that individuals with SMI have lower fitness levels and increased risk of losing physical independence than those without SMI.

Each authors’ contributions

Potential referees

Lili Ji, PhD. University of Minnesota, 100 Church Street SE Minneapolis, MN 55455-0213 Twin Cities, United States; E-mail: [e-mail].

Yong Zhang, PhD.Tianjin University of Sport, No. 16, Donghai Road, Jinghai District, Tianjin, 301617, China; E-mail: [e-mail].

Conflict of interest

The authors have no conflicts of interest to report.

Acknowledgments

The authors thank Hetong nursing home and Yanan hospital for recruiting participants and providing a pleasant study area. The authors are grateful for the help of the undergraduates and postgraduates at Tianjin University of Sport during testing.

Our research was sponsored by the National General Administration of Sport, China (2015B015, Study on the demonstration community how to keep seniors fit through exercise,2016.1-2018.12).

References

[1] C.R. Conti, A.A. Bavry, J.W. Petersen. Silent ischemia clinical relevance. J Am Coll Cardiol, 59 ( 2012), pp. 435-441, DOI: 10.1016/j.jacc.2011.07.050

[2] N.J. Wimmer, B.M. Scirica, P.H. Stone. The clinical significance of continuous ECG (ambulatory ECG or Holter) monitoring of the ST-segment to evaluate ischemia: a review. Prog Cardiovasc Dis, 56 ( 2013), pp. 195-202, DOI: 10.1016/j.pcad.2013.07.001

[3] M.B. O'Steen, N.S. Kleiman. Silent ischemia. J.T. Willerson, H.J.J. Wellens, J.N. Cohn, D.R. Holmes (Eds.), Cardiovascular Medicine, Springer, London ( 2007), DOI: 10.1007/978-1-84628-715-2_32

[4] M. Petretta, G. Fiumara, M.P. Petretta, A. Cuocolo. Detection of silent myocardial ischemia: is it clinically relevant?. J Nucl Cardiol, 20 (5) ( 2013), pp. 707-710, DOI: 10.1007/s12350-013-9725-z

[5] C.J. Pepine, N.L. Geller, G.L. Knatterud, et al.. The asymptomatic cardiac ischemia pilot (acip) study: design of a randomized clinical trial, baseline data and implications for a long-term outcome trial. J Am Coll Cardiol, 24 ( 1994), pp. 1-10, DOI: 10.1016/0735-1097(94)90534-7

[6] P.G. Camici, F. Crea. Coronary microvascular dysfunction. N Engl J Med, 356 ( 2007), pp. 830-840, DOI: 10.1056/NEJMra061889

[7] R. Asmar, A. Benetos, B. Pannier, et al.. Prevalence and circadian variations of ST-segment depression and its concomitant blood pressure changes in asymptomatic systemic hypertension. Am J Cardiol, 77 ( 1996), p. 384, DOI: 10.1016/S0002-9149(97)89369-1

[8] M. Stramba-Badiale, O. Bonazzi, C. Casadei GDal Palù, B. Magnani, A. Zanchetti. Prevalence of episodes of ST-segment depression among mild-to-moderate hypertensive patients in northern Italy: the cardio-screening study. J Hypertens, 16 ( 1998), pp. 681-688, DOI: 10.1097/00004872-199816050-00016

[9] D. Boon, J.J. Piek, G.A. Van-Montfrans.Silent ischaemia and hypertension. J Hypertens, 18 ( 2000), p. 1355, DOI: 10.1097/00004872-200018100-00002

[10] A.D.C. Azevedo, P.J.D. Souza, M.S. Bueno, L.H. Loyola, S.S. Albuquerque, J.A. Sekeff. Silent myocardial ischemia: its increase with aging. Arq Bras Cardiol, 57 ( 1991), pp. 281-285

[11] B.J. Lee, Y.G. Jin, A.R. Kim, et al.. Quality of life and physical ability changes after hospital-based cardiac rehabilitation in patients with myocardial infarction. Ann Rehabil Med, 41 ( 2017), pp. 121-128, DOI: 10.5535/arm.2017.41.1.121

[12] S. Heo, T.A. Lennie, C. Okoli, D.K. Moser. Quality of life in patients with heart failure: ask the patients. Heart Lung, 38 ( 2009), pp. 100-108, DOI: 10.1016/j.hrtlng.2008.04.002

[13] M.R. Law, H.C. Watt, N.J. Wald. The underlying risk of death after myocardial infarction in the absence of treatment. Arch Intern Med, 162 ( 2002), pp. 2405-2410, DOI: 10.1001/archinte.162.21.2405

[14] W.J. Chodzko-Zajko, D.N. Proctor, M.A.F. Singh, et al.. Exercise and physical activity for older adults. Med Sci Sport Exerc, 41 ( 2009), pp. 992-1008, DOI: 10.1249/MSS.0b013e3181a0c95c

[15] R.E. Rikli, C.J. Jones. Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years. Gerontol, 53 ( 2003), pp. 255-267, DOI: 10.1093/geront/gns071

[16] T.M. Gill, H. Allore, T.R. Holford, Z. Guo. The development of insidious disability in activities of daily living among community-living older persons. Am J Med, 117 ( 2004), pp. 484-491, DOI: 10.1016/j.amjmed.2004.05.018

[17] J.M. Guralnik, L. Ferrucci, C.F. Pieper, et al.. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci, 55 ( 2002), pp. M221-M231, DOI: 10.1093/Gerona/55.4.M221

[18] R. Milte, M. Crotty. Musculoskeletal health, frailty and functional decline. Best Pract Res Clin Rheumatol, 28 ( 2014), pp. 395-410, DOI: 10.1016/j.berh.2014.07.005

[19] S. Malhotra, R. Sharma, D. Kliner, W.P. Follansbee, P. Soman. Relationship between silent myocardial ischemia and coronary artery disease risk factors. J Nucl Cardiol, 20 ( 2013), pp. 731-738, DOI: 10.1007/s12350-013-9708-0

[20] D.D. Gutterman, D. David. Silent myocardial ischemia. Circulation, 113 ( 2009), pp. 785-797, DOI: 10.1253/circj.cj-08-1209

[21] R.E. Rikli, C.J. Jones. Senior fitness test manual. J Aging Phys Act, 10 ( 2001), pp. 110-111, DOI: 10.1016/j.jphys.2015.04.001

[22] B. Langhammer, J.K. Stanghelle. The senior fitness test. J Physiother, 61 ( 2015), DOI: 10.1016/j.jphys.2015.04.001. 163-163

[23] R.E. Rikli, C.J. Jones. Development and validation of a functional fitness test for a community-residing adults. J Aging Phys Act, 7 ( 1999), pp. 129-161, DOI: 10.1123/japa.7.2.129

[24] E.A. Marques, F. Baptista, R. Santos, et al.. Normative functional fitness standards and trends of Portuguese older adults: cross-cultural comparisons. J Aging Phys Act, 22 ( 2014), pp. 126-137, DOI: 10.1123/japa.2012-0203

[25] E. Cerin, A. Barnett, M.C. Cheung, C.H.P. Sit, D.J. Macfarlane, W.M. Chan. Reliability and validity of the IPAL-L in a sample of Hong Kong urban older adults: does neighborhood of residence matter?. J Aging Phys Act, 20 ( 2012), pp. 402-420, DOI: 10.1123/japa.20.4.402

[26] J.A. Bennett, K. Winters-Stone, L.M. Nail, J. Scherer. Definitions of sedentary in physical-activity-intervention trials: a summary of the literature. J Aging Phys Act, 14 ( 2006), pp. 456-477, DOI: 10.1123/japa.14.4.456

[27] D.H. Paterson, D.E. Warburton.Physical activity and functional limitations in older adults: a systematic review related to Canada's physical activity guidelines. Int J Behav Nutr Phys Act, 7 ( 2010), p. 38, DOI: 10.1186/1479-5868-7-38

[28] S. Jackson, D.M. Nielsen, N.D. Singh. Increased exposure to acute thermal stress is associated with a non-linear increase in recombination frequency and an independent linear decrease in fitness in drosophila. BMC Evol Biol, 15 ( 2015), pp. 1-8, DOI: 10.1186/s12862-015-0452-8

[29] G.C. Vagetti, V.D. Oliveira, M.P. Silva, A.B. Pacífico, T.R.A. Costa, W. de Campor. Association of body mass index with the functional fitness of elderly women attending a physical activity program. Rev Bras Geriatr Gerontol, 20 ( 2017), pp. 214-224, DOI: 10.1590/1981-22562017020.160160

[30] S. Hidese, J. Matsuo, I. Ishida, et al.. Relationship of handgrip strength and body mass index with cognitive function in patients with schizophrenia. Front Psychiatry, 9 ( 2018), p. 156, DOI: 10.3389/fpsyt.2018.00156

[31] S. Gontarev, R. Kalac, V. Zivkovic, L.A. Velickovska, B. Telai. The association between high blood pressure, physical fitness and fatness in adolescents. Nutr Hosp, 34 ( 2017), pp. 35-40, DOI: 10.7752/jpes.2016.s2165

[32] Virgílio Viana Ramires, et al..Fernando César Wehrmeister, Andrea Wendt Böhm, Physical activity levels objectively measured among older adults: a population-based study in a southern city of Brazil. Int J Behav Nutr Phys Act, 14 ( 2017), p. 13, DOI: 10.1186/s12966-017-0465-3

[33] M.J. Zellweger, R. Hachamovitch, X. Kang, et al.. Threshold, incidence, and predictors of prognostically high-risk silent ischemia in asymptomatic patients without prior diagnosis of coronary artery disease. J Nucl Cardiol, 16 ( 2009), pp. 193-200, DOI: 10.1007/s12350-008-9016-2

[34] R. Hachamovitch, D.S. Berman, H. Kiat, et al.. Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification. Circulation, 93 ( 1996), pp. 905-914, DOI: 10.1161/01.CIR.93.5.905

[35] E. Biagini, A.F.L. Schinkel, J.J. Bax, et al.. Long term outcome in patients with silent versus symptomatic ischaemia during dobutamine stress echocardiography. Heart, 91 ( 2015), pp. 737-742, DOI: 10.1136/hrt.2004.041087

[36] K.L. Rice, A.D. Paterson, G.M. Jones. Ageing and physical activity: evidence to develop exercise recommendations for older adults. Can J Public Health, 98 ( 2007), pp. S69-S108, DOI: 10.1139/H07-111

[37] X. Wang, Y. Ma, J. Wang, et al.. Mobility and muscle strength together are more strongly correlated with falls in suburb-dwelling older Chinese. Sci Rep, 6 ( 2016), p. 25420, DOI: 10.1038/srep25420

[38] Services H, Physical activity guidelines advisory committee report. To the secretary of health and human services. Part A: executive summary. Nutr Rev, 2009 (67) ( 2008), pp. 114-120, DOI: 10.1111/j.1753-4887.2008.00136.x

[39] S. Zizzi, D. Goodrich, Y. Wu, et al.. Correlates of physical activity in a community sample of older adults in Appalachia. J Aging Phys Act, 14 ( 2006), pp. 423-438, DOI: 10.1123/japa.14.4.423

[40] L.B. Sardinha, D.A. Santos, E.A. Marques, J. Mota. Criterion-referenced fitness standards for predicting physical independence into later life. Exp Gerontol, 61 ( 2015), pp. 142-146, DOI: 10.1016/j.exger.2014.12.012

[41] A.M. Thompson, T.S. Church, I. Janssen, P.T. Katzmarzyk, C.P. Earnest, S.N. Blair. Cardiorespiratory fitness as a predictor of cancer mortality among men with pre-diabetes and diabetes. Diabetes Care, 31 ( 2008), pp. 764-769, DOI: 10.2337/dc07-1648

[42] P. McAuley, J. Myers, B. Emerson, R.B. Oliveira, C.L. Blue, PittsleyJ, V.F. Froelicher. Cardiorespiratory fitness and mortality in diabetic men with and without cardiovascular disease. Diabetes Res. Clin. Pract., 85 (3) ( 2009), pp. e30-e33, DOI: 10.1016/j. diabres.2009.05.012

[43] L. Sandvik, J. Erikssen, E. Thaulow, G. Erikssen, R. Mundal, K. Rodahl. Physical fitness as a predictor of mortality among healthy, middle-aged norwegian men. N. Engl. J. Med., 328 (8) ( 1993), pp. 533-537, DOI: 10.1056/NEJM199302253280803