Aerobic physical activity, cardiorespiratory fitness, and non-communicable diseases risk in older adults: a systematic review

Background
Non-communicable diseases (NCDs) account for an estimated 80% of the healthcare burden among older adults globally. Aerobic physical activity (PA) contributes to functional mobility, increased bone and muscle strength, prevention of illness and quality of life; however, PA is not yet a fully realised aspect of geriatric care.

Objective
To review recent evidence for the impact of aerobic PA and cardiorespiratory fitness (CRF) on mortality and NCD outcomes in adults aged ≥ 65 years.

Methods
Following PRISMA guidelines, we performed a systematic search of the Scopus, Cochrane Library, PubMed and Web of Science databases, published between 2016 and February 2024.

Results
The 94 included studies (reported in 104 individual manuscripts) included 46 cross-sectional, 24 longitudinal, 7 cross-sectional/longitudinal, 1 intervention/cross-sectional, and 16 interventions studies. PA and CRF were consistently associated with reduced all-cause mortality in longitudinal studies. Most included studies reported inverse associations between measures of PA and cardiovascular disease (CVD, n = 14 of 16 studies) risk and measures of dysglycaemia (n = 12 of 16 studies). Obesity/adiposity, blood pressure, lipids, and metabolic syndrome (MetS) were not consistently associated with aerobic PA. While aerobic PA interventions generally improved depression outcomes, longitudinal studies showed inconclusive results. Observational evidence suggests an association between PA and frailty, but less consistently with falls.

Conclusion
This review suggests a beneficial association between aerobic PA and all-cause mortality, CVD, dysglycaemia, and frailty, with inconsistent evidence for associations with obesity, dyslipidaemia, hypertension, MetS, depression, and falls. Given the inconsistent findings for key metabolic outcomes, future research is needed to address outstanding and understudied questions around risk reversibility and time to benefit for PA interventions, as well as identifying target groups who benefit more from PA and tailoring interventions to these groups. Further longitudinal studies are also needed to determine the optimal frequency, duration, and intensity of aerobic PA for mitigating NCD risk in older adults.