Effect of 5 years of exercise training on the cardiovascular risk profile of older adults: the Generation 100 randomized trial

Jon Magne Letnes, Ida Berglund, Kristin E Johnson, Håvard Dalen, Bjarne M Nes, Stian Lydersen, Hallgeir Viken, Erlend Hassel, Sigurd Steinshamn, Elisabeth Kleivhaug Vesterbekkmo, Asbjørn Støylen, Line S Reitlo, Nina Zisko, Fredrik H Bækkerud, Atefe R Tari, Jan Erik Ingebrigtsen, Silvana B Sandbakk, Trude Carlsen, Sigmund A Anderssen, Maria A Fiatarone Singh, Jeff S Coombes, Jorunn L Helbostad, Øivind Rognmo, Ulrik Wisløff, Dorthe Stensvold, Jon Magne Letnes, Ida Berglund, Kristin E Johnson, Håvard Dalen, Bjarne M Nes, Stian Lydersen, Hallgeir Viken, Erlend Hassel, Sigurd Steinshamn, Elisabeth Kleivhaug Vesterbekkmo, Asbjørn Støylen, Line S Reitlo, Nina Zisko, Fredrik H Bækkerud, Atefe R Tari, Jan Erik Ingebrigtsen, Silvana B Sandbakk, Trude Carlsen, Sigmund A Anderssen, Maria A Fiatarone Singh, Jeff S Coombes, Jorunn L Helbostad, Øivind Rognmo, Ulrik Wisløff, Dorthe Stensvold

Abstract

Aims: The aim of this study was to compare the effects of 5 years of supervised exercise training (ExComb), and the differential effects of subgroups of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), with control on the cardiovascular risk profile in older adults.

Methods and results: Older adults aged 70-77 years from Trondheim, Norway (n = 1567, 50% women), able to safely perform exercise training were randomized to 5 years of two weekly sessions of HIIT [∼90% of peak heart rate (HR), n = 400] or MICT (∼70% of peak HR, n = 387), together forming ExComb (n = 787), or control (instructed to follow physical activity recommendations, n = 780). The main outcome was a continuous cardiovascular risk score (CCR), individual cardiovascular risk factors, and peak oxygen uptake (VO2peak). CCR was not significantly lower [-0.19, 99% confidence interval (CI) -0.46 to 0.07] and VO2peak was not significantly higher (0.39 mL/kg/min, 99% CI -0.22 to 1.00) for ExComb vs. control. HIIT showed higher VO2peak (0.76 mL/kg/min, 99% CI 0.02-1.51), but not lower CCR (-0.32, 99% CI -0.64 to 0.01) vs. control. MICT did not show significant differences compared to control or HIIT. Individual risk factors mostly did not show significant between-group differences, with some exceptions for HIIT being better than control. There was no significant effect modification by sex. The number of cardiovascular events was similar across groups. The healthy and fit study sample, and contamination and cross-over between intervention groups, challenged the possibility of detecting between-group differences.

Conclusions: Five years of supervised exercise training in older adults had little effect on cardiovascular risk profile and did not reduce cardiovascular events.

Registration: ClinicalTrials.gov: NCT01666340.

Keywords: Ageing; Cardiorespiratory fitness; Cardiovascular risk factors; Exercise; High-intensity interval training.

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

Figures

Graphical Abstract
Graphical Abstract
Five years of supervised exercise did not significantly improve the cardiovascular risk profile of older adults compared to a control group advised to follow national recommendations for physical activity. In comparisons between the different exercise intensities there was a signal towards a favourable effect in the high-intensity interval training group for several of the risk factors, but the present study did not show conclusive evidence.
Figure 1
Figure 1
Flowchart of participant inclusion and follow-up. The number of participants showing up for repeated examination and testing at each study year is shown in the box below each intervention group. HIIT, high-intensity interval training; MICT, moderate-intensity continuous training.
Figure 2
Figure 2
(A) Men and (B) women. Descriptive data presented as means and 99% confidence intervals for each risk factor at study Years 0 (baseline), 1, 3, and 5 by the three intervention arms. The combination of HIIT and MICT (ExComb) is not shown. BMI, body mass index; BP, blood pressure; CCR, continuous cardiovascular risk score; FFM, fat-free mass; HbA1c, glycosylated haemoglobin; HIIT, high-intensity interval training; HDL, high-density lipoprotein; LDL, low-density lipoprotein; MAP, mean arterial pressure; MICT, moderate-intensity continuous training group; TG, triglycerides; VO2peak, peak oxygen uptake.
Figure 2
Figure 2
Continued.

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