Zusammenfassung
Bereits ab dem 30. Lebensjahr nimmt die maximale körperliche Leistungfähigkeit kontinuierlich
mit steigendem Lebensalter ab - um etwa 10 % pro Lebensdekade. Als Konsequenz dieser
Entwicklung leiden ältere Menschen > 65 Jahre in besonderem Maße unter einer Einschränkung
der körperlichen Leistungsfähigkeit als Folge der kardialen, vaskulären und muskulären
Alterserscheinungen. Diese natürlichen altersbedingten Veränderungen machen alte Menschen
besonders anfällig für die zentral-kardialen und peripheren Alteration, die eine chronische
Herzinsuffizienz (CHI) mit sich bringt. Die Funktionseinschränkungen unterscheiden
sich dabei nicht qualitativ grundsätzlich von den altersbedingten Veränderungen -
sie überlagern sich diesen oft unmerklich.
Durch körperliche Aktivität kann ein bedeutender Anteil der Funktionseinschränkung
von Vasomotorik, Skelettmuskelfunktion und kardialer Leistungsreserve wiedergewonnen
werden. Bisher existieren noch keine systematischen Vergleichsstudien zur Altersabhängigkeit
der Trainingseffekte, kleinere Beobachtungsstudien und Subgruppenanalysen legen jedoch
den Schluss nahe, dass der trainingsbedingte Gewinn an Leistungsfähigkeit im Alter
proportional dem (niedrigeren) Ausgangswert nicht geringer als bei jüngeren Patienten
ausfällt. Im Vordergrund körperlicher Aktivität im Alter steht dabei die Erhaltung
von Muskelkraft und Muskelmasse sowie die Übung der motorischen Koordination. Ziel
ist letztlich die Reduktion der CHI-bedingten Morbidität: Immerhin sind aktuell 79
% der wegen CHI hospitalisierten Patienten älter als 65 Jahre.
Summary
Maximal exercise capacity undergoes a steady decline after the age of 30 by approximately
10 % per decade. As a consequence of this development older people > 65 years of
age suffer from the exercise limitation caused by age-associated cardiac, vascular
and skeletal muscle changes. These physiologic alterations make older people especially
vulnerable for the cardiovascular and peripheral alterations associated with chronic
heart failure (CHF). These changes are not phenomenologically differerent from age-associated
changes.
Physical activity plays an important role for regaining a considerable part of vasomotor
function, skeletal muscle contractility, and cardiac reserve. Up to now there are
no prospective trials comparing the effects of physical training between older and
younger patients with CHF. However, smaller observational studies indicate that elderly
patients benefit equally well from training interventions with regard to functional
improvements in proportion to their lower baseline values.
In an aging population training aims at maintaining skeletal muscle force and muscle
mass as well as locomotor coordination. Ultimately, the goal is to reduce the subsantial
morbidity among elderly CHF patients which constitute 79 % of all hospital admissions
for heart failure.
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Prof. Dr. med. Rainer Hambrecht
Universität Leipzig - Herzzentrum, Klinik für Innere Medizin/Kardiologie
Strümpellstraße 39
04289 Leipzig
Telefon: 0341/8651428
Fax: 0341/8651461
eMail: hamr@medizin.uni-leipzig.de
