Health benefits of exercise in an aging society.

The effects of regular aerobic exercise are important to an aging society increasingly preoccupied with exercise. Traditionally, most attention has been directed to the relationship between a physically active life-style and cardiovascular mortality. In an aging society, however, active life expectancy and maintenance of independence may be as important as effects of regular exercise on longevity. Regular exercise results in increased maximum aerobic capacity due to peripheral changes in muscle (increased capacity for aerobic metabolism and improved substrate and oxygen extraction with a widened arteriovenous oxygen difference) and also due to cardiovascular changes with increased stroke volume and cardiac output in normal persons. "Therapeutic benefits" of conditioning probably occur at submaximal work loads common to everyday activity, when cardiac work and myocardial oxygen consumption are less for any given work load, muscles are more efficient, and relative oxygen requirements are less. Aging is associated with a linear decline in maximum aerobic capacity. The rate of decline is twofold greater when comparing sedentary with physically active middle-aged men. Thus, regular exercise could conceivably lower functional aerobic age by slowing this functional decline. Exercise, particularly excessive exercise, is also associated with serious hazards, including sudden death, nonfatal myocardial infarction, excessive fatigue, hyperthermia, and significant musculoskeletal problems. Accounts of the health effects of exercise should consider a wide range of risks and benefits, especially those related to improving function, minimizing disability, and prolonging independent living.