---

EFFECT OF EXERCISE ON PULMONARY FUNCTION IN ELDERLY

P P Mehrotra, S V Joshi, AH Shah, H L Dhar
Bombay Hospital and Medical Research Centre, Mumbai - 20.

---

Effect of exercise on pulmonary functions (VC, EFV1, MVV and PEFR) was studied in 40 (M 29, F 11) elderly subjects (60-81 yrs) and in 60 (M 31, F 29) younger age group (12-55 yrs). However, there was no significant change in any parameter except MVV (61.24 ± 21.23 lit before and 74.86 ± 23.18 lit after exercise) in younger females. Older females could not do exercise for 8 minutes.

EIA index also was not different in elderly (8.98) from younger (8.46) male subjects.

Exercise induced asthma (EIA) in healthy young subjects has been reported. [1] However there is no exact data of exercise induced bronchospasm in elderly subjects in this country. Pulmonary function (PFT) studies as such have been reported in young [3, 4] and elderly [5,6] healthy subjects as well as in relation to environmental conditions amongst students. [2]

Present study was undertaken to obtain detailed information about the effect of exercise on PFT in the elderly compared with adults. Attempt has been made to find out incidence of exercise induced asthma (EIA) based on EIA index.

MATERIAL AND METHODS

40 (29 M, 11 F) elderly subjects, age varying from 60-81 years and 60 (31 M, 29 F) young subjects (12-55 years) were included in this study.

After thorough medical examination the subjects were asked to perform pulmonary function test using Medspiror (a computerised electronic device) and Wright’s peak flow meter. Their height, weight, BP and pulse were recorded and following parameters of pulmonary function were determined i.e. VC, EFV1, MVV and PEFR.

The subjects were then asked to do the exercise using bicycle ergometer (with fixed speed and resistance established earlier) for 8 minutes and pulmonary functions were repeated. PEFR was however recorded every two minutes starting from 0 minute to 8 minutes and at 22nd minute after starting exercise using peak flow meter.

RESULTS

Male female ratio of 100 subjects (60 young and 40 elderly) has been shown in Table 1. Different parameters of pulmonary function i.e. VC, FEV1, MVV and PEFR have been shown in tables.2-5

Table 1
Age (in years)
Parameter	Young		Elderly
	Male	Female	Male	Female
N	31	29	29	11
X	34.45	29.55	68.27	62.18
SD (±)	± 12.72	± 8.95	± 6.16	± 6.69
Range	12-55	12-45	60-81	60-73

The pulmonary function studies were compared before and after exercise in both the groups. There is apparent improvement in VC, EFV1, MVV and PEFR after exercise. But the change was not significant except in case of MVV in females (Table 4). EIA index was worked out according to the formula. [1, 7]

Table 2
VC (Lit) Mean ± SD
Sex	Young			Elderly
	Before Exercise		After Exersise	Before Exercise		After Exersise
Male(n)	2.45± 0.57 (31)	NS : P>0.05	2.62± 0.62 (29)	1.91± 0.59 (29)	NS : P > 0.05	1.98± 0.60 (14)
Female(n)	1.75± 0.52 (29)	NS : P>0.05	1.77± 0.54 (21)	1.44± 0.33 (11)		_

Table 3
EFV1 (Lit) Mean ± SD
Sex	Young			Elderly
	Before Exercise		After Exersise	Before Exercise		After Exersise
Male(n)	2.01± 0.56 (31)	NS : P>0.05	2.06± 0.57 (29)	1.44± 0.48 (29)	NS : P > 0.05	1.49± 0.54 (14)
Female(n)	1.46± 0.42 (29)	NS : P>0.05	1.54± 0.48 (21)	1.24± 0.28 (11)		_

Table 4
MVV (Lit) Mean ± SD
Sex	Young			Elderly
	Before Exercise		After Exersise	Before Exercise		After Exersise
Male(n)	88.45± 28.15 (31)	NS : P>0.05	95.66± 9.15 (29)	68.62± 0.48 (29)	NS : P > 0.05	79.92± 2.73 (14)
Female(n)	61.24± 21.23 (29)	P > 0.05	41.54± 0.48 (21)	41.54± 17.32 (11)		_

Resting PEFR - lowest PEFR x 100 / Resting PEFR

The EIA index in both young and elderly has been shown in Table 6. In the young it was 8.46 ± 5.83 in males and 9.13 ± 7.03 in the females. In the elderly corresponding figure was 8.98± 3.85 in male, however, females could not do the exercise for 8 minutes. Results of pulmonary function have been further analysed (Figs. 1-4).

DISCUSSION

Exercise induced bronchospasm (EIB) can be best viewed as a syndrome of exaggerated response to exercise in certain individuals rather than a distinct disease entity. In the susceptible individual asthmatic attacks can be elicited by a diverse range of stimuli of which exercise is a natural and safer stimulus. [7] Normal individuals may develop mild airway obstruction only after strenuous exercise, however, the change in airway responsiveness before and after exercise in asthma are not well defined. [8] In a recent study incidence of exercise induced bronchospasm was found to be as high as 77.5% in adult asthmatics compared to none in control subjects[9] where a fall of more than 15% in PEFR was considered as EIA.[9] In a previous study in Indian adults it was established that incidence of EIA index was 5.79% in males and 6.25% in females based on 25% reduction in PEFR. [1] Recently it has been reported that 6% of US military adult healthy population suffer from EIA. [10]

Table 5
PEFR (Lit/mt) Mean ± SD
Sex	Young			Elderly
	Before Exercise		After Exersise	Before Exercise		After Exersise
Male(n)	438.45± 112.15 (31)	NS : P>0.05	476.89± 97.90 (29)	409.93± 77.42 (29)	NS : P > 0.05	420.71± 96.81 (14)
Female(n)	339.66± 75.19 (29)	P > 0.05	360.68± 79.26 (21)	41.54± 17.32 (11)		_

Table 6
EIA Index
Parameter	Young		Elderly
	Male	Female	Male	Female
N	16	11	10	_
X	8.46	9.13	8.98	_
± SD	± 5.83	± 7.03	± 3.85	_
Range	0.92 - 21.05	1.67 - 22.73	4.23 - 16.44	_

Fig. 1 : VC (Lit).	Fig. 2 : EFV1 (Lit).
Fig. 3 : MVV (Lit).	Fig. 4 : PEFR (Lit/min).

In the present study EIA index was 8.46 in young males, 9.13 in young females and 8.98 in elderly males based on Jone’s bronchial index[7] however, elderly females could not do exercise as per criteria laid down. To our information EIA in healthy Indian elderly has not been reported elsewhere.

Results show that elderly subjects are more prone to bronchospasm compared to adults. None of the present subjects had given history of bronchial asthma and can be considered as normal subject and none of them was excluded as there was no marked fall in PEFR values below 15%[9, 11] or 25%[1,12] after exercise. There was no significant change in the values of pulmonary function (VC, EFV1, MVV, PEFR) in young male subjects however, there was significant increase in MVV values in females after exercise. It is possible that ventilatory drive is higher in females after exercise.

REFERENCES

1. Pargaonkar KA, Dhar HL. Evaluation of exercise induced asthma (EIA), effects of various drugs. A double blind cross over study, advances in asthmology, eds. K. Kobayash and JA Bellanti, 1990; 569-75.
2. Shahani SR, Pargaonkar KA, Dhar HL. Effect of different factors on pulmonary function. Current Med Proct 1988; 33 (4) : 724-28.
3. Kasliwal RM, Baldwa VS, Sharma PH. Ventilatory tests and lung volumes studies in health. J IMA 1964; 43 : 49-51.
4. Mathur KS, Nigam DK, Garg RK. Pulmonary function studies in normal healthy persons. Ind Jour Chest Dis 1968; 10 : 80-89.
5. Pathak JD, Mehrotra PP, Joshi SV, Shah AH. Pulmonary functions of the elderly Indian subjects: Trends of decline with age. Ind J Physiol Pharmacol 1989; 33 (3) : 157-62.
6. Meenakshi S. Spirom data in South Indian subjects 60-80 yrs. Indian J Physiol Pharmacol 1984; 28 : 58-62.
7. Jones RS. Exercise tests and resp. function. Edward Arnold Publication 25, Hill Street, London, 1976; 84-92.
8. Koh YY, Lim HS, Min KU, Kim YY. Maximal airway narrowing on the dose response curve to methacholine is increased after exercise induced bronchoconstriction. J asthma 1996; 33 (1) : 55-65.
9. Erhabor GE, Awotedu AA, Balogun MD. Exercise induced broncho constriction in Nigerian asthmatics. Aft J Med Sci 1993; 22 (2) : 33-7.
10. O’Donnell AE, Fling J. Exercise induced air flow obstruction in a healthy military population, Chest 1993; 103 (3) : 742-4.
11. Weiler JM. Exercise induced asthma: A practical guide to definition, diagnosis, prevalence and treatment. Allerg-Asthma proc 1996; 17 (6) : 315-25.
12. Anderson AS, Silverman M, Konig P, et al. EIA, Brit J Dis Chest 1979; 69 : 1-39.

---

To Section TOC