Ejection Fraction at Rest vs. Exercise in Older Adults
Ejection Fraction (EF) is a measurement of how much blood the left ventricle pumps out with each contraction, expressed as a percentage. A normal resting EF is typically between 55% and 70%. For healthy, non-sedentary individuals, the surprising answer to whether does ejection fraction get worse with age at rest is no; studies have shown that it may be preserved or even increase slightly.
However, the heart's response to physical stress and exercise tells a different story. Research demonstrates that while a young, healthy adult's EF significantly increases with maximal exercise, the EF for a healthy older adult shows a much smaller rise and can even decrease. This reveals a critical difference in how the aging heart functions under different conditions. The resting heart may appear healthy, but its diminished ability to augment its pumping capacity during exertion reflects a reduced cardiovascular reserve capacity.
Why the Heart's Exercise Response Changes
Several factors contribute to the blunted exercise response seen in older adults, even in the absence of clinical heart disease:
- Increased Arterial Stiffness: With age, arteries become thicker, stiffer, and less elastic due to decreased elastin and increased collagen deposits. This causes an increase in afterload—the resistance the heart must pump against—requiring the heart muscle to work harder and making the left ventricle remodel over time.
- Reduced Beta-Adrenergic Responsiveness: The body's response to adrenaline, managed by beta-adrenergic receptors, diminishes with age. This blunts the heart's ability to increase heart rate and contractility during exercise, limiting the potential for a higher EF.
- Decreased Ventricular Compliance: The heart muscle becomes stiffer and less able to relax fully during the filling phase (diastole). This causes older adults' hearts to become more reliant on the atrial contraction to complete ventricular filling, which is compromised under stress.
- Lifestyle Factors: A sedentary lifestyle significantly contributes to decreased ventricular compliance and worsens age-related cardiac changes.
The Impact of Comorbidities and Heart Failure
While healthy aging involves adaptive changes, the presence of comorbidities can accelerate adverse changes and lead to heart failure, even with a seemingly normal EF. This condition is known as Heart Failure with Preserved Ejection Fraction (HFpEF) and is highly prevalent in older adults.
| Heart Failure Type Comparison | Feature | Heart Failure with Reduced Ejection Fraction (HFrEF) | Heart Failure with Preserved Ejection Fraction (HFpEF) |
|---|---|---|---|
| Ejection Fraction (EF) | Usually 40% or lower. | Typically 50% or higher, in the normal range. | |
| Underlying Problem | The heart muscle is weak and can't pump forcefully enough. | The heart muscle is stiff and can't fill properly between beats. | |
| Common Causes | Coronary artery disease, prior heart attack, and dilated cardiomyopathy. | Long-term high blood pressure, diabetes, obesity, and age-related changes. | |
| Prevalence in Elderly | Less common than HFpEF in older adults. | More common in older adults, especially women. |
For patients with HFpEF, factors beyond simple EF are central to diagnosis and management. The stiffening of the heart muscle and reduced cardiovascular reserve, influenced by conditions like high blood pressure, diabetes, and obesity, are key drivers of symptoms.
Maintaining a Healthy Ejection Fraction as You Age
For many, a decline in EF is not an inevitable outcome of aging, especially if preventative measures are taken. Lifestyle modifications and medical management are critical for maintaining cardiovascular health and EF, especially during exercise.
- Regular Physical Activity: Consistent, moderate-intensity aerobic exercise, such as walking, can improve the heart's strength and efficiency, enhance circulation, and help maintain or even improve EF over time.
- Heart-Healthy Diet: Adopting a diet rich in fruits, vegetables, and whole grains while limiting sodium intake can reduce fluid retention and decrease the heart's workload.
- Managing Chronic Conditions: Controlling underlying risk factors like high blood pressure, diabetes, and high cholesterol is essential for preventing or slowing heart muscle damage.
- Weight Management: Maintaining a healthy weight reduces the strain on the heart and is particularly important for mitigating the risks associated with HFpEF.
- Quit Smoking and Limit Alcohol: Unhealthy habits like smoking and excessive alcohol use can worsen heart failure symptoms and should be avoided.
Conclusion
So, does ejection fraction get worse with age? Not necessarily, especially at rest. In healthy individuals, the heart adapts, and resting EF can remain stable or even increase. However, the heart's reserve capacity during exercise typically diminishes. Furthermore, comorbidities like hypertension, diabetes, and obesity, which become more common with age, are significant risk factors for heart failure with preserved ejection fraction (HFpEF). Focusing on a heart-healthy lifestyle, including regular exercise and managing chronic conditions, is the most effective strategy for preserving optimal heart function and cardiovascular reserve throughout the aging process.
Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice. Please consult with a healthcare provider for any concerns regarding your heart health.
