




















































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































ANNALES KINESIOLOGIAE • 8 • 2017 • 2

111

Review article               UDC: 796.012:613.2
received: 2017-06-16

BENEFITS OF AEROBIC EXERCISE TRAINING WITH 
RECOMMENDATIONS FOR HEALTHY AGING

Enrico REJC1,2, Alessio DEL TORTO1,3, Stefano LAZZER1,3

1 Department of Medicine, University of Udine, Italy.
2 University of Louisville, Department of Neurological Surgery, Louisville, USA.

3 School of Sport Sciences, University of Udine, Italy.

Corresponding author:
Prof. Stefano LAZZER

University of Udine
Department of Medicine

P.le Kolbe 4
33100 Udine, Italy.

Phone: +39 0432 494333 - Fax: +39 0432 494301
e-mail: stefano.lazzer@uniud.it

ABSTRACT

The purpose of this articlet is to provide an overview of the importance of aerobic 
exercise and its characteristics for healthy aging. The first section briefly reviews the 
effects of aging on maximal aerobic power; Section 2 considers the effects of aerobic 
exercise training, and Section 3 summarizes the recommendations and some limita-
tions of the current guidelines for aerobic exercise training. Physical activity cannot 
stop the biological processes; however, there is evidence that regular aerobic exercise 
can minimize the physiological effects of an otherwise sedentary lifestyle and increase 
active life expectancy by limiting the development and progression of chronic disease 
and disability conditions. The use of moderately standardized guidelines for exercise 
prescription resulted in safe and effective impact on health-related outcomes. 

Keywords: aerobic exercise; physical activity; training.



112

Enrico REJC, Alessio DEL TORTO, Stefano LAZZER: BENEFITS OF AEROBIC EXERCISE TRAINING WITH RECOMMENDATIONS ..., 111–124

ANNALES KINESIOLOGIAE • 8 • 2017 • 2

POZITIVNI UČINKI AEROBNE VADBE S PRIPOROČILI ZA 
ZDRAVO STARANJE

IZVLEČEK

Namen tega članka je podati pregled razpoložljivih informacij o pomenu aerobne 
vadbe in njenih lastnosti za zdravo staranje. V prvem delu so na kratko predstavlje-
ni učinki staranja na maksimalno aerobno moč. Drugi del obravnava učinke aerobne 
vadbe, medtem ko so v tretjem delu povzeta priporočila ter nekatere omejitve trenutno 
veljavnih smernic za aerobno vadbo. Telesna aktivnost ne more ustaviti bioloških pro-
cesov. Kljub temu pa je na voljo precej dokazov, da redna aerobna vadba zmanjšuje 
fiziološke učinke sicer sedentarnega življenjskega sloga ter obenem podaljšuje pričako-
vano življenjsko dobo s tem, ko omejuje nastanek in razvoj kroničnih bolezni ter pogo-
jev invalidnosti. Uporaba zmernih standardiziranih smernic pri predpisovanju telesne 
vadbe, se odraža neposredno v varnih in učinkovitih vplivih na zdravje in z zdravjem 
povezana pričakovanja.

Ključne besede: aerobna vadba, telesna aktivnost, vadba.

INTRODUCTION

The most widely used terms of maximal aerobic functional power are peak and 
maximum oxygen uptake (V’O2peak and V’O2max). Both terms are often used as thou-
gh they are synonymous, but there are important distinctions to be made between them 
(Whipp, Davis, Torres, & Wasserman, 1981). While the V’O2peak is easier to define 
and determine, its relevance to physiological and patho-physiological functioning is 
less secure. It is, simply, the highest value of V’O2 attained on the particular test, most 
commonly an incremental or other high-intensity test designed to bring the subject to 
the limit of tolerance – neglecting considerations of what time, or breath-number, fra-
me of reference is chosen for the determination. Unfortunately, it is the highest value 
achieved regardless of the subject’s effort. And so while it defines the highest V’O2 that 
was attained during the test it does not necessarily define the highest value attainable 
by the subject. This value is the V’O2max: a term introduced by Hill and Lupton in 
1923 (Hill & Lupton, 1923) as ‘‘the oxygen intake during an exercise intensity at which 
actual oxygen intake reaches a maximum beyond which no increase in effort can raise 
it”; its rigorous determination depends on a particular criterion having been met. Con-
sidering this, the demonstration V’O2 does not continue to increase, or only to increase 
by a trivially-small amount, despite further increases in work rate “involving a large 
proportion of muscle mass” i.e., a V’O2 “plateau” shows results when V’O2 is plotted 
as a function of work rate. 



ANNALES KINESIOLOGIAE • 8 • 2017 • 2

113

Enrico REJC, Alessio DEL TORTO, Stefano LAZZER: BENEFITS OF AEROBIC EXERCISE TRAINING WITH RECOMMENDATIONS ..., 111–124

Cross-sectional studies show that V’O2peak typically declines 6 − 10 % per age 
decade in healthy men and women (Talbot, Metter, & Fleg, 2000; Wilson & Tanaka, 
2000; Aspenes et al., 2011). However, the older individuals included in these studies 
conceivably presented favourable genetics as well as lifestyle differences, thus limiting 
the generalization of findings for their age peers. In a longitudinal study, a decline in 
peak V’O2 of 20 − 25 % per decade was shown in 70+ healthy elderly subjects (Fig. 1) 
(Fleg et al., 2005). Hawkins et al. (Hawkins, Marcell, Victoria Jaque, & Wiswell, 2001) 
also subdivided the sample of master athletes by age group and found that loss rates 
in maximal oxygen uptake (V’O2max) increased with age, from rates similar to those 
reported for sedentary subjects in the younger master athletes to rates four times greater 
than sedentary subjects in the older master athletes (Figure 1). The declines of 20 − 30 
% per decade most likely reflect the periods of rapid decline associated with reductions 
in physical activity and exercise. These findings suggest that either accelerates the re-
duction in V’O2max or increases the difficulty of maintaining training.

Decline in V’O2max can be attributed to age-related reductions in both maximal 
cardiac output (Q’max) and maximal arteriovenous oxygen (a-v O2) difference in se-
dentary subjects, while in older endurance-trained individuals only the reduction of 
Q’max might explain the age-induced decline in maximal aerobic power (Ogawa et 
al., 1992). Maximal heart rate decreases about six to ten beats per minute per decade, 
and is responsible for much of the age-associated decrease in Q’max (Hawkins et al., 
2001). However, a reduction in stroke volume during maximal exercise in older adults 
also contributes to the decline in cardiac output (Hagberg et al., 1985). In addition, 
left ventricular ejection fraction appears to be reduced in older adults during maximal 
exercise compared to young adults (Taylor & Groeller, 2008; Thomas, Paterson, Cun-
ningham, McLellan, & Kostuk, 1993). Decreases in vascular capacity and local blood 
flow regulation, along with a decline in muscle oxidative capacity contribute to the 
overall reduction in maximal a-v O2 difference observed with age (Sagiv, Goldhammer, 
Ben-Sira, & Amir, 2010; Toda, 2012). Coupled with poor oxygen delivery mechanisms, 
mitochondrial alterations also lead to a reduction in maximal capacity to utilize oxygen 
at the level of active skeletal muscle. For a submaximal exercise bout, cardiac output is 
lower in older adults, while a-v O2 difference may tend to increase as a compensatory 
response to maintain V’O2. A reduction in stroke volume appears to be the major factor 
responsible for the lower cardiac output observed during submaximal exercise (Ogawa 
et al., 1992). Blood pressure is also higher in absolute as well as relative work rates in 
older adults as compared to younger adults. In addition, total peripheral resistance is 
generally higher in older adults for a given exercise intensity (Ogawa et al., 1992). 

Although reduced physical activity with age contributes to decrease the maximal 
aerobic power, similar rates of decline are observed with age even among highly active 
individuals. However, the V’O2peak of such athletic persons is substantially higher 
than that of their age peers (Fleg et al., 1994). Moreover, the cardiovascular (CV) sy-
stem remains fully adaptable to training at any age (Kohrt et al., 1991) with relative inc-
reases in V’O2max in adults of any age equivalent to those seen in young individuals. 
Given the effect of cardio vascular exercise training and greater fitness on CV disease 



114

Enrico REJC, Alessio DEL TORTO, Stefano LAZZER: BENEFITS OF AEROBIC EXERCISE TRAINING WITH RECOMMENDATIONS ..., 111–124

ANNALES KINESIOLOGIAE • 8 • 2017 • 2

Figure 1: Cross-sectional versus longitudinal comparison of loss rates in maximal oxy-
gen consumption (V’O2max) [mL/kg/min] in men and women master athletes (adapted 
from Hawkins & Wiswell, 2003).

**: Significantly different rate of loss compared with cross-sectional.



ANNALES KINESIOLOGIAE • 8 • 2017 • 2

115

Enrico REJC, Alessio DEL TORTO, Stefano LAZZER: BENEFITS OF AEROBIC EXERCISE TRAINING WITH RECOMMENDATIONS ..., 111–124

risk factors (Kelley & Sharpe Kelley, 2001), mortality, and all-cause mortality (Myers 
et al., 2002), recommending aerobic activity to adults of all ages would seem prudent 
(Balady, 2002).

EFFECTS OF AEROBIC EXERCISE TRAINING 

The ability to maintain high aerobic power is a major determinant of an older adult’s 
functional independence. Several observational studies have demonstrated that endu-
rance athletes, even those in their 60s and beyond, maintain a V’O2peak considerably 
higher than the one of less active age peers. For example, the V’O2peak in distance 
runners aged 60 − 80 years was 30 − 40 % higher than active non-trained age peers in 
the Baltimore Longitudinal Study of (BLSA). In fact, their aerobic capacity was similar 
to that of BLSA participants 2 or 3 decades younger (Fleg et al., 1994).

As well, data from the Heritage Family Study suggest that genetics explains 47 % 
of the V’O2peak response to 20 weeks of aerobic exercise training after adjustment 
for age, sex, baseline V’O2peak, and baseline body mass and composition (Bouchard, 
2012). Additionally, multiple studies have documented training-induced increases of 
10 − 25 % in V’O2peak among adults in their 60s to 80s, and these increases are similar 
to those in younger adults (Vaitkevicius et al., 2002). A meta-analysis of training stu-
dies in persons aged 60 and older found a mean increase in V’O2peak of 16% (Huang, 
Gibson, Tran, & Osness, 2005). In general, higher intensity training and longer exercise 
duration elicited greater improvement.

In addition to its beneficial effects on aerobic capacity, exercise training produces 
multiple benefits that reduce risk factors for CV disease.

Hypertension

Hypertension is defined by a systolic blood pressure (BP) ≥140 mmHg and / or 
diastolic BP ≥90 mmHg, and it represents the leading risk factor for global burden of 
disease and mortality (Roger et al., 2012). High blood pressure contributes to 7.0 % 
of disability-adjusted life-years and 9.4 million deaths. Also, the estimated number of 
adults with hypertension will be increased to 1.56 billion by 2025 (Hu et al., 2016). 
The prevalence of hypertension increases with age and it represents a risk factor for 
the most common causes of morbidity and mortality in older age such as stroke, ische-
mic heart disease, heart failure and coronary events (Lloyd-Sherlock, Beard, Minicuci, 
Ebrahim, & Chatterji, 2014).

In both younger and older persons with hypertension, regular aerobic exercise re-
duces BP. Important mechanisms contributing to exercise-related BP reduction include 
a decrease in aortic stiffness and enhanced flow-mediated arterial dilation due to incre-
ased nitric oxide release from endothelial cells lining these blood vessels (DeSouza et 
al., 2000). The reductions in BP from aerobic exercise are often similar to those induced 



116

Enrico REJC, Alessio DEL TORTO, Stefano LAZZER: BENEFITS OF AEROBIC EXERCISE TRAINING WITH RECOMMENDATIONS ..., 111–124

ANNALES KINESIOLOGIAE • 8 • 2017 • 2

by a single antihypertensive drug. Mean BP reduction in a large meta-analysis averaged 
3.8-2.6 mmHg (Whelton, Chin, Xin, & He, 2002). It is important to point out that lower 
intensity exercise equivalent to brisk walking demonstrated BP reductions similar to 
that of more intensive training in older hypertensive adults (Hagberg, Montain, Martin, 
& Ehsani, 1989).

Dyslipidemia

Abnormal blood lipids are powerful risk factors for CV events in older adults. Ae-
robic exercise training has beneficial effects on these abnormal lipid levels, irrespective 
of age. In a meta-analysis of aerobic exercise training trials in older adults, significant 
increases in high density lipoprotein (HDL) or “good” cholesterol averaged 2.5 mg/
dl, and reduced total cholesterol / HDL cholesterol ratio were observed, independent 
of changes in body composition; improvements in blood lipids correlated with increa-
ses in V’O2peak (Kelley, Kelley, & Tran, 2005). Weight loss, which is often observed 
during prolonged training programs, may further improve lipid profile (Katzel et al., 
1995).

Glucose Tolerance

Aging is accompanied by reduced insulin sensitivity, which impairs glucose tole-
rance. This adaptation often results in type 2 diabetes mellitus, which itself is a potent 
risk factor for atherosclerotic CV disease. Both age-associated increase in body fat and 
reduced physical activity appear to contribute to the impairment of insulin sensitivity 
and glucose tolerance in older adults. Thus, it is not surprising that both weight reduc-
tion and aerobic exercise training ameliorate these impairments. A 9-month aerobic 
exercise intervention in 71 obese older men (61 ± 1 years, BMI 30.4 ± 0.4 [mean ± SD] 
) increased V’O2peak by a mean of 17 % (P < 0.001) and reduced area (under the glyca-
emic curve) of an oral glucose tolerance test by an equal amount (Katzel et al., 1995).

Bone Density

Reduction in bone density associated with aging occurs in both sexes but accelera-
tes in women after menopause, increasing risk for osteoporotic-related fractures, thus, 
worsening the quality of life. Bonaiuti et al. (2002) reported an increase in bone mineral 
density of hips and spine by 1.3 % and 0.9 %, respectively (P= 0.055 and P = 0.011, 
respectively), following walking activity. (Hatori et al., 1993) also showed an increase 
of bone mineral density of 1.1 ± 2.9 % (P < 0.05) in postmenopausal healthy women 
(45 to 67 years) following a 7-month training protocol that consisted of 30 minutes of 
high-intensity walking performed three times per week. Although estrogen replace-



ANNALES KINESIOLOGIAE • 8 • 2017 • 2

117

Enrico REJC, Alessio DEL TORTO, Stefano LAZZER: BENEFITS OF AEROBIC EXERCISE TRAINING WITH RECOMMENDATIONS ..., 111–124

ment therapy reduces post-menopausal bone loss, the negative cardio vascular effects 
of estrogen have markedly curtailed its use. It seems worth noting that reduced bone 
mineral density can represent a potential threat for the health status of an individual. In 
fact, as mentioned above, reduced bone mineral density can increase the risk of frac-
tures, which affects quality of life and leads to physical inactivity. Fortunately, weight 
bearing aerobic as well as resistance exercise can increase bone density in older adults 
by increasing the loading force on bone and stimulating osteoblast activity.

Depression

In a case-control study, the INERHEART study, it was found that psychological 
factors (e.g. depression, perceived stress and life events) were strong risk factors for 
myocardial infarction. Also, depression was officially recognized as a CV risk factor 
following the 2010 Global Burden of Disease Study and other studies (Yusuf et al., 
2004; Elderon & Whooley, 2013). While it seems important to reiterate that modifiable 
health behaviour (e.g. physical inactivity, poor diet, smoking, dyslipidemia and medi-
cation non-adherence) are conceivably the most critical mediators for CV disease, the 
role of depression on CV diseases and physical (in)activity should be considered (Pan, 
Sun, Okereke, Rexrode, & Hu, 2011; Hamer, 2012). In fact, some studies reported 
associations between physical inactivity, depression and CV mortality also in the aged 
population (Win et al., 2011). In particular, the primary finding of Win and colleagues 
(2011) was that physical inactivity accounted for approximately 25 % of the increased 
risk of CV mortality due to depression in community-dwelling aged adults. Furthermo-
re, Whooley et al. (2008) showed that, in a batch of outpatients with stable coronary 
heart disease, physical inactivity explained almost half of the association between de-
pressive symptoms and CV events. Interestingly, in addition to the beneficial effects 
of cognitive behavioural therapy and antidepressant medication, regular exercise has 
been shown to reduce depressive symptoms. For example, Lavie and Milani (1995) 
have shown lower depression scores, reduced anxiety, and improved total quality of 
life (QOL) after cardiac rehabilitation (CR) in 85+ coronary patients. The program 
lasted 12 weeks in which 36 exercise and educational sessions were performed. Each 
session included: i) around 10 minutes of warm-up stretching and calisthenics; ii) 30 
to 40 minutes of continuous upright aerobic and dynamic exercise (various combinati-
ons of walking, bicycling, jogging, rowing, etc.), along with light isometric exercises 
(e.g. hand weights); iii) around 10-minute cool-down period of stretching. The exercise 
intensity was prescribed with the aim of making patients attain approximately 75 % to 
85 % of their maximal heart rate, or 10 to 15 beats per minute below the level of any 
exercise induced myocardial ischemia. The exercise prescriptions were periodically 
adjusted to guarantee a gradual increase in exercise performance. Moreover, all patients 
were oftentimes supported by physicians, dieticians, nurses, and exercise physiologists 
to comply with the exercise program (Lavie & Milani, 1995).



118

Enrico REJC, Alessio DEL TORTO, Stefano LAZZER: BENEFITS OF AEROBIC EXERCISE TRAINING WITH RECOMMENDATIONS ..., 111–124

ANNALES KINESIOLOGIAE • 8 • 2017 • 2

LONG-TERM BENEFITS OF EXERCISE IN OLDER ADULTS

Despite the study results on physiological benefits of exercise in older adults re-
viewed above, elderly people are more concerned about their functional independence 
and QOL than laboratory measurements. As noted earlier, the ability to perform daily 
activities generally requires an aerobic power > 20 mL/kg/min (Cress & Meyer, 2003). 
Ehsani et al. (2003) reported a V’O2peak of 15.6 ± 2.7 ml/kg/min in frail octogenarians 
women; similarly, (Ades, Ballor, Ashikaga, Utton, & Nair, 1996) found a peak aerobic 
power equal to 21.5 ± 1.1 ml / kg / min in old women (70.4±4 years). These findings 
highlight the fact that older individuals are extremely close to the threshold for loss of 
independence (Cress & Meyer, 2003). In this population, regular aerobic training may 
prevent or significantly delay the crossing of “independence threshold”; furthermore 
ongoing clinical trials are rigorously examining the effects of regular exercise in pre-
serving independence and reducing morbidity and mortality (Mazzeo & Tanaka, 2001).

Older adults are conceivably more concerned about their QOL than their longevity 
per se. Thus, improving and maintaining high QOL assumes great importance in the 
aged population. Because QOL is adversely impacted by illness and disability, impro-
ved physical function might be expected to cause parallel increases in QOL. In HF-
-ACTION, a trial of supervised aerobic exercise training followed by home exercise in 
adults with moderate-to-severe CHF, QOL improved significantly with training (Flynn 
et al., 2009). Similarly Austin, Williams, Ross, Moseley, & Hutchison (2005) observed 
improved QOL in 200 patients 60 − 89 years old (mean 72 years) after a 24-week pro-
gram of aerobic exercise plus low-resistance strength training.

Aging is accompanied by an accelerating reduction of functional capacity, best 
quantified by V’O2max and / or V’O2peak; the degradation of maximal aerobic power 
is also induced by many comorbidities common to the older individuals (Huggett, Con-
nelly, & Overend, 2005). However, numerous observational and interventional studies 
have demonstrated the beneficial effects of exercise training in older adults, both in 
healthy and diseased individuals (Mazzeo & Tanaka, 2001). A major challenge con-
fronting the medical community and society is to increase significantly the participation 
of the aged population in such activities.

RECOMMENDATIONS FOR AEROBIC EXERCISE TRAINING 

Current recommendations for improving CV fitness and reducing disease risks are 
certainly effective (Chodzko-Zajko et al., 2009), even though further research is needed 
to identify the minimum effective dosage for intensity and volume to improve V’O2max 
and reduce disease and mortality outcomes. These recommendations call for 15 – 60 
minutes of aerobic activities that include large muscles, rhythmic movement, 3 – 5 days 
per week, at an intensity equivalent to 40 – 85 % of V’O2max (55-90% HRmax). This 
means that practicing exercise at high intensity and volume, just like athletes would, 



ANNALES KINESIOLOGIAE • 8 • 2017 • 2

119

Enrico REJC, Alessio DEL TORTO, Stefano LAZZER: BENEFITS OF AEROBIC EXERCISE TRAINING WITH RECOMMENDATIONS ..., 111–124

is not a prerequisite for significant improvements in CV performance and health status 
in general.

The practice of light- to moderate-intensity physical activity on a more frequent 
basis, on the other hand, is identified as a requirement to optimize health by the recent 
guidelines issued by the Centers for Disease Control and Prevention / American Col-
lege of Sports Medicine (ACSM) (Pate et al., 1995). This should be the main focus 
of aerobic exercise prescription for adults of all ages (Balady, 2002). Therefore, the 
ACSM guidelines should provide the basis for exercise prescription for most adults 
(Chodzko-Zajko et al., 2009). The current consensus recommendations of the ACSM 
and American Heart Association (AHA) with respect to the frequency, intensity, and 
duration of exercise and physical activity for older adults are summarized below. 

The ACSM / AHA Physical Activity Recommendations are generally consistent 
with the 2008 Physical Activity Guidelines for Americans by the Department of Health 
and Human Services (DHHS) (Physical Activities Guidelines Advisory Committee, 
2008), which also recommend 150 minutes / week of physical activity for health bene-
fits. However, the DHHS Guidelines note that additional benefits occur as the amount 
of physical activity increases through higher intensity, greater frequency, and / or longer 
duration. The DHHS Physical Activity Guidelines point out that if older adults cannot 
perform 150 min of moderate-intensity aerobic activity per week because of chronic 
conditions, they should be as physically active as their abilities and conditions allow. 

Main recommendations for aerobic exercise training

Frequency: For moderate-intensity activities, accumulate at least 30 or up to 60 (for 
greater benefit) minutes / day in bouts of at least 10 min each to total 150 – 300 minutes 
/ week, at least 20 – 30 minutes / day or more of vigorous-intensity activities to total 
75 – 150 minutes / week, an equivalent combination of moderate and vigorous activity.

Intensity: On a scale of 0 to 10 for level of physical exertion, 5 to 6 for moderate-
-intensity and 7 to 8 for vigorous intensity. 

Duration: For moderate-intensity activities, accumulate at least 30 minutes / day 
in bouts of at least 10 min each or at least 20 minutes / day of continuous activity for 
vigorous-intensity activities. 

Type: Any modality that does not impose excessive orthopaedic stress; walking is 
the most common type of activity. Aquatic exercise and stationary cycle exercise may 
be advantageous for those with limited tolerance for weight bearing activity.

Despite the extremely favourable health outcomes promoted by the above described 
physical activity, it may be argued that the proposed exercise guidelines are too generic. 
The adoption of a common prescription approach may not allow to achieve the full 
therapeutic potential of physical exercise treatment. In fact, these guidelines do not take 
into account some crucial aspects of exercise prescription, such as the recovery period 
among each training session (especially between the ones carried out at high intensity 
and / or high volume) as well as training periodization and the individualization of 



120

Enrico REJC, Alessio DEL TORTO, Stefano LAZZER: BENEFITS OF AEROBIC EXERCISE TRAINING WITH RECOMMENDATIONS ..., 111–124

ANNALES KINESIOLOGIAE • 8 • 2017 • 2

training variables (volume, intensity and frequency) based on the individual needs of 
the older individuals. In particular, it is known that periodized training promotes better 
physical improvements compared to non-periodized training programs in the healthy 
population, and this may conceivably be the case also for non-healthy individuals (Is-
surin, 2010). Another positive aspect of periodization is the reduced risk of overtraining 
and its side effects (Fry, Morton, & Keast, 1992). ACSM guidelines also reported that 
exercise and physical activity progression for older adults should be individualized, 
also using exercise tolerance as an additional criteria (Chodzko-Zajko et al., 2009).

 

CONCLUSIONS

A body of evidence clearly indicates that involvement in exercise programs in-
duces several benefits for older individuals. These favourable ameliorations involve 
noteworthy health-related issues including CV disease, metabolic syndrome, diabetes 
mellitus and osteoporosis. However, not only the cardio-metabolic profile is improved 
in response to exercise program, indeed, it is reported that physical activity positively 
affects also more functional benefits that allow for continued independence and the 
ability to perform daily life activities and reduced cognitive symptoms (e.g. depression 
and anxiety). As a matter of fact, all these exercise-induced benefits are vanished if 
the aged population is not involved in a regular physical activity regime. Nowadays, 
extreme importance is placed on the development of new strategies and educational 
programs with the aim to inform the older population about the meaningful benefits 
of regular exercise and increase their involvement, adherence and compliance to such 
programs.

REFERENCES

Ades, P. A., Ballor, D. L., Ashikaga, T., Utton, J. L., & Nair, K. S. (1996). Weight training 
improves walking endurance in healthy elderly persons. Annals of Internal Medicine, 
124(6), 568-572. doi: 10.7326/0003-4819-124-6-199603150-00005 VIEW ITEM

Aspenes, S. T., Nilsen, T. I., Skaug, E. A., Bertheussen, G. F., Ellingsen, O., Vatten, 
L., & Wisloff, U. (2011). Peak oxygen uptake and cardiovascular risk factors in 4631 
healthy women and men. Medicine & Science in Sports & Exercise, 43(8), 1465-1473. 
doi: 10.1249/MSS.0b013e31820ca81c VIEW ITEM

Austin, J., Williams, R., Ross, L., Moseley, L., & Hutchison, S. (2005). Randomised con-
trolled trial of cardiac rehabilitation in elderly patients with heart failure. European Jo-
urnal of Heart Failure, 7(3), 411-417. doi: 10.1016/j.ejheart.2004.10.004 VIEW ITEM

Balady, G. J. (2002). Survival of the fittest--more evidence. New England Journal of Medi-
cine, 346, 852-854. doi: 10.1056/NEJM200203143461111 VIEW ITEM

Bonaiuti, D., Shea, B., Iovine, R., Negrini, S., Robinson, V., Kemper, H. C., ... Cran-
ney, A. (2002). Exercise for preventing and treating osteoporosis in postmenopa-

https://doi.org/10.7326/0003-4819-124-6-199603150-00005
https://doi.org/10.1249/MSS.0b013e31820ca81c
https://doi.org/10.1016/j.ejheart.2004.10.004
https://doi.org/10.1056/NEJM200203143461111


ANNALES KINESIOLOGIAE • 8 • 2017 • 2

121

Enrico REJC, Alessio DEL TORTO, Stefano LAZZER: BENEFITS OF AEROBIC EXERCISE TRAINING WITH RECOMMENDATIONS ..., 111–124

usal women. Cochrane Database of Systematic Reviews, 2, art. no. CD000333. doi: 
10.1002/14651858.CD000333 VIEW ITEM

Bouchard, C. (2012). Genomic predictors of trainability. Experimental Physiology, 97(3), 
347-352. doi: 10.1113/expphysiol.2011.058735 VIEW ITEM

Chodzko-Zajko, W. J., Proctor D. N., Fiatarone Singh, M. A., Minson, C. T., Nigg, 
C. R., Salem, G. J., & Skinner, J. S., (2009). Exercise and physical activity for ol-
der adults. Medicine & Science in Sports & Exercise, 41(7), 1510–1530. doi: 10.1249/
MSS.0b013e3181a0c95c VIEW ITEM

Cress, M. E. & Meyer, M. (2003). Maximal voluntary and functional performance levels 
needed for independence in adults aged 65 to 97 years. Physical Therapy, 83(1), 37-48. 
doi: 10.1093/ptj/83.1.37 VIEW ITEM

DeSouza, C. A., Shapiro, L. F., Clevenger, C. M., Dinenno, F. A., Monahan, K. D., 
Tanaka, H., & Seals, D. R. (2000). Regular aerobic exercise prevents and restores age-
-related declines in endothelium-dependent vasodilation in healthy men. Circulation, 
102(12), 1351-1357. doi: 10.1161/01.CIR.102.12.1351 VIEW ITEM

Ehsani, A. A., Spina, R. J., Peterson, L. R., Rinder, M. R., Glover, K. L., Villareal, D. 
T., Binder, E. F. & Holloszy, J. O. (2003). Attenuation of cardiovascular adaptations to 
exercise in frail octogenarians. Journal of Applied Physiology, 95(5), 1781-1788. doi: 
10.1152/japplphysiol.00194.2003 VIEW ITEM

Elderon, L., & Whooley, M. A. (2013). Depression and cardiovascular disease. Progress in 
Cardiovascular Diseases, 55(6), 511-523. doi: 10.1016/j.pcad.2013.03.010 VIEW ITEM

Fleg, J. L., Morrell, C. H., Bos, A. G., Brant, L. J., Talbot, L. A., Wright, J. G., & Lakat-
ta, E. G. (2005). Accelerated longitudinal decline of aerobic capacity in healthy older 
adults. Circulation, 112(5), 674-682. doi: 10.1161/CIRCULATIONAHA.105.545459 
VIEW ITEM

Fleg, J. L., Schulman, S. P., O’Connor, F. C., Gerstenblith, G., Becker, L. C., Fortney, 
S., Goldberg, A. P., & Lakatta, E.G. (1994). Cardiovascular responses to exhaustive 
upright cycle exercise in highly trained older men. Journal of Applied Physiology, 77(3), 
1500-1506. doi: 10.1152/jappl.1994.77.3.1500 VIEW ITEM

Flynn, K. E., Piña, I. L., Whellan, D. J., Lin, L., Blumenthal, J. A., Ellis, S. J., ... Wein-
furt, K. P. (2009). Effects of exercise training on health status in patients with chronic 
heart failure: HF-ACTION randomized controlled trial. JAMA, 301(14), 1451-1459. 
doi: 10.1001/jama.2009.457 VIEW ITEM

Fry, R. W., Morton, A. R., & Keast, D. (1992). Periodisation and the prevention of over-
training. Canadian Journal of Sport Sciences, 17(3), 241-248. 

Hagberg, J. M., Allen, W. K., Seals, D. R., Hurley, B. F., Ehsani, A. A., & Holloszy, 
J. O. (1985). A hemodynamic comparison of young and older endurance athletes 
during exercise. Journal of Applied Physiology, 58(6), 2041-2046. doi: 10.1152/ja-
ppl.1985.58.6.2041 VIEW ITEM

Hagberg, J. M., Montain, S. J., Martin, W. H. 3rd, & Ehsani, A. A. (1989). Effect of 
exercise training in 60- to 69-year-old persons with essential hypertension. The Ameri-
can journal of Cardiology, 64(5), 348-353. doi: 10.1016/0002-9149(89)90533-X VIEW 
ITEM

Hamer, M. (2012). Psychosocial stress and cardiovascular disease risk: the role of physical 
activity. Psychosomatic Medicine, 74(9), 896-903. doi: 10.1097/PSY.0b013e31827457f4 
VIEW ITEM

https://doi.org/10.1002/14651858.CD000333
https://doi.org/10.1113/expphysiol.2011.058735
https://doi.org/10.1249/MSS.0b013e3181a0c95c
https://doi.org/10.1093/ptj/83.1.37
https://doi.org/10.1161/01.CIR.102.12.1351
https://doi.org/10.1152/japplphysiol.00194.2003
https://doi.org/10.1016/j.pcad.2013.03.010
https://doi.org/10.1161/CIRCULATIONAHA.105.545459
https://doi.org/10.1152/jappl.1994.77.3.1500
https://doi.org/10.1001/jama.2009.457
https://doi.org/10.1152/jappl.1985.58.6.2041
https://doi.org/10.1016/0002-9149(89)90533-X
https://doi.org/10.1016/0002-9149(89)90533-X
https://doi.org/10.1097/PSY.0b013e31827457f4


122

Enrico REJC, Alessio DEL TORTO, Stefano LAZZER: BENEFITS OF AEROBIC EXERCISE TRAINING WITH RECOMMENDATIONS ..., 111–124

ANNALES KINESIOLOGIAE • 8 • 2017 • 2

Hatori, M., Hasegawa, A., Adachi, H., Shinozaki, A., Hayashi, R., Okano, H., ... Mu-
rata, K. (1993). The effects of walking at the anaerobic threshold level on vertebral 
bone loss in postmenopausal women. Calcified Tissue International, 52(6), 411-414. 
doi: 10.1007/BF00571327 VIEW ITEM

Hawkins, S. A., & Wiswell, R. A. (2003). Rate and mechanism of maximal oxygen con-
sumption decline with aging: implications for exercise training. Sports Medicine, 
33(12), 877-888. doi: 10.2165/00007256-200333120-00002 VIEW ITEM

Hawkins, S. A., Marcell, T. J., Victoria Jaque, S., & Wiswell, R. A. (2001). A longi-
tudinal assessment of change in VO2max and maximal heart rate in master athletes. 
Medicine & Science in Sports & Exercise, 33(10), 1744-1750. doi: 10.1097/00005768-
200110000-00020 VIEW ITEM

Hill, A. V., & Lupton, H. (1923). Muscular exercise, lactic acid, and the supply and utili-
zation of oxygen. Quarterly Journal of Medicine, 16(62), 135-171. doi: 10.1093/qjmed/
os-16.62.135 VIEW ITEM

Hu, Z., Liu, F., Li, M., He, J., Huang, J., Rao, D. C., … Xueli Yang, X. (2016). Asso-
ciations of Variants in the CACNA1A and CACNA1C genes with longitudinal blood 
pressure changes and hypertension incidence: The GenSalt Study , American Journal of 
Hypertension, 29(11), 1301–1306. doi: 10.1093/ajh/hpw070 VIEW ITEM

Huang, G., Gibson, C. A., Tran, Z. V., & Osness, W.H. (2005). Controlled endurance 
exercise training and VO2max changes in older adults: a meta-analysis. Preventive Car-
diology, 8(4), 217-225. doi: 10.1111/j.0197-3118.2005.04324.x VIEW ITEM

Huggett, D. L., Connelly, D. M., & Overend, T. J. (2005). Maximal aerobic capacity te-
sting of older adults: a critical review. The Journals of Gerontology. Series A, Biological 
Sciences and Medical Sciences, 60(1), 57-66. doi: 10.1093/gerona/60.1.57 VIEW ITEM

Issurin, V. B. (2010). New horizons for the methodology and physiology of training peri-
odization Sports Medicine, 40(3) 189-206. doi: 10.2165/11319770-000000000-00000 
VIEW ITEM

Katzel, L. I., Bleecker, E. R., Colman, E. G., Rogus, E. M., Sorkin, J. D., & Goldberg, 
A. P. (1995). Effects of weight loss vs aerobic exercise training on risk factors for coro-
nary disease in healthy, obese, middle-aged and older men. A randomized controlled tri-
al. JAMA, 274(24), 1915-1921. doi: 10.1001/jama.1995.03530240025035 VIEW ITEM

Kelley, G. A, Kelley, K. S., & Tran, Z. V. (2005). Exercise, lipids, and lipoproteins in ol-
der adults: a meta-analysis. Preventive Cardiology, 8(4), 206-214. doi: 10.1111/j.0197-
-3118.2005.03769.x VIEW ITEM

Kelley, G. A., & Sharpe Kelley, K. (2001). Aerobic exercise and resting blood pressure 
in older adults: a meta-analytic review of randomized controlled trials. Journals of Ge-
rontology. Series A, Biological Sciences and Medical Sciences, 56(5), M298-303. doi: 
10.1093/gerona/56.5.M298 VIEW ITEM

Kohrt, W. M., Malley, M. T., Coggan, A. R., Spina, R. J., Ogawa, T., Ehsani, A. A., ... 
Holloszy, J. O. (1991). Effects of gender, age, and fitness level on response of VO-
2max to training in 60-71 yr olds. Journal of Applied Physiology, 71(5), 2004-2011. doi: 
10.1152/jappl.1991.71.5.2004 VIEW ITEM

Lavie, C. J, & Milani, R. V. (1995). Effects of cardiac rehabilitation and exercise training 
on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life 
in women. The American journal of Cardiology, 75(5), 340-343. doi: 10.1016/S0002-
9149(99)80550-5 VIEW ITEM

https://doi.org/10.1007/BF00571327
https://doi.org/10.2165/00007256-200333120-00002
https://doi.org/10.1097/00005768-200110000-00020
https://doi.org/10.1093/qjmed/os-16.62.135
https://doi.org/10.1093/ajh/hpw070
https://doi.org/10.1111/j.0197-3118.2005.04324.x
https://doi.org/10.1093/gerona/60.1.57
https://doi.org/10.2165/11319770-000000000-00000
https://doi.org/10.1001/jama.1995.03530240025035
https://doi.org/10.1111/j.0197-3118.2005.03769.x
https://doi.org/10.1093/gerona/56.5.M298
https://doi.org/10.1152/jappl.1991.71.5.2004
https://doi.org/10.1016/S0002-9149(99)80550-5


ANNALES KINESIOLOGIAE • 8 • 2017 • 2

123

Enrico REJC, Alessio DEL TORTO, Stefano LAZZER: BENEFITS OF AEROBIC EXERCISE TRAINING WITH RECOMMENDATIONS ..., 111–124

Lloyd-Sherlock, P., Beard, J., Minicuci, N., Ebrahim, S., & Chatterji, S. (2014). Hyper-
tension among older adults in low- and middle-income countries: prevalence, awareness 
and control. International Journal of Epidemiology, 43(1), 116-128. doi: 10.1093/ije/
dyt215 VIEW ITEM

Mazzeo, R. S., & Tanaka, H. (2001). Exercise prescription for the elderly: current recom-
mendations. Sports Medicine, 31(11), 809-818. doi: 10.2165/00007256-200131110-
00003 VIEW ITEM

Myers, J., Prakash, M., Froelicher, V., Do, D., Partington, S., & Atwood, J. E. (2002). 
Exercise capacity and mortality among men referred for exercise testing. New England 
Journal of Medicine, 346, 793-801. doi: 10.1056/NEJMoa011858 VIEW ITEM

Ogawa, T., Spina, R. J., Martin, W. H. 3rd, Kohrt, W. M., Schechtman, K. B., Holloszy, 
J. O., & Ehsani, A. A. (1992). Effects of aging, sex, and physical training on cardiova-
scular responses to exercise. Circulation, 86(2), 494-503. doi: 10.1161/01.CIR.86.2.494 
VIEW ITEM

Pan, A., Sun, Q., Okereke, O. I., Rexrode, K. M., & Hu, F. B. (2011). Depression and 
risk of stroke morbidity and mortality: a meta-analysis and systematic review. JAMA, 
306(11), 1241-1249. doi: 10.1001/jama.2011.1282 VIEW ITEM

Pate, R. R., Pratt, M., Blair, S. N., Haskell, W. L., Macera, C. A., Bouchard, C., ... 
Wilmore, J. H. (1995). Physical activity and public health. A recommendation from the 
Centers for Disease Control and Prevention and the American College of Sports Medi-
cine. JAMA, 273(5), 402-407. doi: 10.1001/jama.1995.03520290054029 VIEW ITEM

Physical Activities Guidelines Advisory Committee. (2008). Physical activity guidelines 
advisory committee report. Washington (DC): US Department of Health and Human 
Services. 

Roger, V. L., Go, A. S., Lloyd-Jones, D. M., Benjamin, E. J., Berry, J. D., Borden, 
W. B., ... Turner, M. B. (2012). Heart disease and stroke statistics--2012 update: a re-
port from the American Heart Association. Circulation 125(1), e2-e220. doi: 10.1161/
CIR.0b013e31823ac046 VIEW ITEM

Sagiv, M., Goldhammer, E., Ben-Sira, D., & Amir, R. (2010). Factors defining oxygen 
uptake at peak exercise in aged people. European Review of Aging and Physical Activi-
ty, 7, 1-2.  doi: 10.1007/s11556-010-0061-x VIEW ITEM

Talbot, L. A., Metter, E. J., & Fleg, J. L. (2000). Leisure-time physical activities and 
their relationship to cardiorespiratory fitness in healthy men and women 18-95 years 
old. Medicine & Science in Sports & Exercise, 32(2), 417-425. doi: 10.1097/00005768-
200002000-00024 VIEW ITEM

Taylor, N. A. S., & Groeller, H. (Eds.) (2008). Physiological bases of human performance 
during work and exercise. Churchill Livingstone: Elsevier.

Thomas, S. G., Paterson, D. H., Cunningham, D. A., McLellan, D. G., & Kostuk, W. 
J. (1993). Cardiac output and left ventricular function in response to exercise in older 
men. Canadian Journal of Physiology and Pharmacology, 71(2), 136-144. doi: 10.1139/
y93-019 VIEW ITEM

Toda, N. (2012). Age-related changes in endothelial function and blood flow regulation. 
Pharmacology & Therapeutics, 133(2), 159-176. doi: 10.1016/j.pharmthera.2011.10.004 
VIEW ITEM

Vaitkevicius, P. V., Ebersold, C., Shah, M. S., Gill, N. S., Katz, R. L., Narrett, M. J., 
... Fleg, J. L. (2002). Effects of aerobic exercise training in community-based subjects 

https://doi.org/10.1093/ije/dyt215
https://doi.org/10.2165/00007256-200131110-00003
https://doi.org/10.1056/NEJMoa011858
https://doi.org/10.1161/01.CIR.86.2.494
https://doi.org/10.1001/jama.2011.1282
https://doi.org/10.1001/jama.1995.03520290054029
https://doi.org/10.1161/CIR.0b013e31823ac046
https://doi.org/10.1007/s11556-010-0061-x
https://doi.org/10.1097/00005768-200002000-00024
https://doi.org/10.1139/y93-019
https://doi.org/10.1016/j.pharmthera.2011.10.004


124

Enrico REJC, Alessio DEL TORTO, Stefano LAZZER: BENEFITS OF AEROBIC EXERCISE TRAINING WITH RECOMMENDATIONS ..., 111–124

ANNALES KINESIOLOGIAE • 8 • 2017 • 2

aged 80 and older: a pilot study. Journal of the American Geriatrics Society, 50(12), 
2009-2013. doi: 10.1046/j.1532-5415.2002.50613.x VIEW ITEM

Whelton, S. P., Chin, A., Xin, X., & He, J. (2002). Effect of aerobic exercise on blood 
pressure: a meta-analysis of randomized, controlled trials. Annals of Internal Medicine, 
136(7), 493-503. doi: 10.7326/0003-4819-136-7-200204020-00006 VIEW ITEM

Whipp, B. J., Davis, J. A., Torres, F., & Wasserman, K. (1981). A test to determine 
parameters of aerobic function during exercise. Journal of Applied Physiology. Re-
spiratory, environmental and exercise physiology, 50(1), 217-221. doi: 10.1152/ja-
ppl.1981.50.1.217 VIEW ITEM

Whooley, M. A., de Jonge, P., Vittinghoff, E., Otte, C., Moos, R., Carney, R. M., ... 
Browner, W. S. (2008). Depressive symptoms, health behaviors, and risk of cardiova-
scular events in patients with coronary heart disease. JAMA, 300(20), 2379-2388. doi: 
10.1001/jama.2008.711 VIEW ITEM

Wilson, T. M., & Tanaka, H. (2000). Meta-analysis of the age-associated decline in 
maximal aerobic capacity in men: relation to training status. American Journal of 
Physiology. Heart and Circulatory Physiology, 278(3), H829-H834. doi: 10.1152/
ajpheart.2000.278.3.H829 VIEW ITEM

Win, S., Parakh, K., Eze-Nliam, C. M., Gottdiener, J. S., Kop, W. J., & Ziegelstein, R. 
C. (2011). Depressive symptoms, physical inactivity and risk of cardiovascular mortali-
ty in older adults: the Cardiovascular Health Study. Heart, 97(6), 500-505. doi: 10.1136/
hrt.2010.209767 VIEW ITEM

Yusuf, S., Hawken, S., Ounpuu, S., Dans, T., Avezum, A., Lanas, F., ... Lisheng, L. 
(2004). Effect of potentially modifiable risk factors associated with myocardial infarc-
tion in 52 countries (the INTERHEART study): case-control study. Lancet 364(9438), 
937-952. doi: 10.1016/S0140-6736(04)17018-9 VIEW ITEM

https://doi.org/10.1046/j.1532-5415.2002.50613.x
https://doi.org/10.7326/0003-4819-136-7-200204020-00006
https://doi.org/10.1152/jappl.1981.50.1.217
https://doi.org/10.1001/jama.2008.711
https://doi.org/10.1152/ajpheart.2000.278.3.H829
http://dx.doi.org/10.1136/hrt.2010.209767
https://doi.org/10.1016/S0140-6736(04)17018-9

