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1 Human Cardiovascular Research
Laboratory, ABSTRACT Fitzgerald, Margaret D., Hirofumi Tanaka, Zung V. Tran, and
Douglas R. Seals. Age-related declines in maximal aerobic capacity
in regularly exercising vs. sedentary women: a meta-analysis. J. Appl. Physiol. 83(1): 160-165, 1997.
aging; exercise; maximal oxygen consumption
INTRODUCTION MAXIMAL AEROBIC CAPACITY, as measured by maximal oxygen
consumption ( In light of the physiological and clinical significance of maximal
aerobic capacity, lifestyle factors that may be associated with a
reduced rate of decline in
In contrast to these findings in men, Wells and colleagues (25) and
Astrand et al. (1) have reported rates of decline in
Accordingly, the primary purpose of the present investigation was to
determine the relationship between habitual aerobic exercise status and
the rate of decline in
To test these hypotheses, we used a meta-analytic approach in which
mean METHODS Meta-analysis is a quantitative approach by which mean results from
different experimental studies are sorted, classified, and summarized
as parametric data (7). It is also the application of research
methodology to the characteristics and findings of studies.
Meta-analysis in the present study was conducted as described previously (24). Briefly, as an initial step, an extensive literature search was conducted to identify as many English-language studies (1960-1996) as possible in which
Our purpose was to determine the relationship between habitual
aerobic exercise status and the rate of decline in maximal aerobic
capacity across the adult age range in women. A meta-analytic approach
was used in which mean maximal oxygen consumption
(
O2 max) values from
female subject groups (ages 18-89 yr) were obtained from the
published literature. A total of 239 subject groups from 109 studies
involving 4,884 subjects met the inclusion criteria and were
arbitrarily separated into sedentary (groups = 107; subjects = 2,256),
active (groups = 69; subjects = 1,717), and endurance-trained (groups = 63; subjects = 911) populations.
O2 max averaged 29.7 ± 7.8, 38.7 ± 9.2, and 52.0 ± 10.5 ml · kg
1 · min1,
respectively, and was inversely related to age within each population (r = 
0.82 to 0.87, all
P < 0.0001). The rate of decline in
O2 max with
increasing subject group age was lowest in sedentary women (3.5
ml · kg1 · min1
· decade1), greater in
active women (4.4
ml · kg1 · min1
· decade1), and
greatest in endurance-trained women (6.2
ml · kg1 · min1 · decade1)
(all P < 0.001 vs. each other). When
expressed as percent decrease from mean levels at age ~25 yr, the
rates of decline in
O2 max were similar
in the three populations (10.0 to 10.9%/decade). There
was no obvious relationship between aerobic exercise status and the
rate of decline in maximal heart rate with age. The results of this
cross-sectional study support the hypothesis that, in contrast to the
prevailing view, the rate of decline in maximal aerobic capacity with
age is greater, not smaller, in endurance-trained vs. sedentary women.
The greater rate of decline in
O2 max in endurance-trained populations may be related to their higher values as
young adults (baseline effect) and/or to greater age-related reductions in exercise volume; however, it does not appear to be
related to a greater rate of decline in maximal heart rate with age.
O2 max),
decreases with advancing age (4, 20). This decrease
contributes to the reduction in physiological functional capacity
observed with advancing age, which eventually can result in a loss of
independence in older adults (5, 9, 12). Moreover, because maximal
aerobic capacity is an independent risk factor for cardiovascular and
all-cause mortality (2, 3), the age-related decrease may also
contribute to premature death in middle-aged and older adults.
O2 max with advancing
age are of considerable public health interest. In this context, it has
been reported that the rate of decline in
O2 max with age is
smaller in endurance-trained male athletes than in sedentary men (8,
11). Based largely on these data in men, the concept has been
established and widely promoted that the rate of decline in maximal
aerobic capacity with age is attenuated in adults who perform regular
aerobic exercise (8, 11, 12).
O2 max with age in
physically active women that are greater than that generally reported
for sedentary women. Recently, we (6) observed a rate of decline in
O2 max with age among
highly trained female distance runners that was even greater than that reported in these earlier studies (1, 25). However, the
relatively small sample sizes, limited age ranges, and lack of
sedentary control groups in all of these studies (1, 6, 25) preclude drawing any conclusions concerning this issue.
O2 max across the adult
age range in women. Our secondary aim was to determine the relationship between aerobic exercise status and the rate of decline in maximal heart rate with age. On the basis of the general prevailing view (8,
11, 12), two specific hypotheses were tested:
1) women performing regular aerobic
exercise demonstrate a slower age-related rate of decline in
O2 max than do
sedentary women; and 2) the slower
rate of decline in
O2 max in women
performing aerobic exercise is associated with a reduced rate of
decline in maximal heart rate, an important determinant of the
age-related reduction in
O2 max (5, 10,
16).
O2 max values of
female subject groups across the adult age range were obtained from the
published literature. The subject groups were classified according to
their aerobic exercise status, and the rate of decline in
O2 max with increasing
subject group age was determined for each of these populations. We
postulated that new insight into these issues might be gained by using
such a large-population approach.
O2 max was measured
in women. This was done by using computer searches (via Sport Discus
and Medline) using the key words aerobic fitness, maximal oxygen
consumption, and women. In addition, extensive hand searching and
cross-referencing were done by using bibliographies of already located
studies. All mean values from previous studies meeting the following
criteria for inclusion were analyzed:
1) data on women reported
separately; 2) age groups separated;
3) at least five subjects per group; 4) only the most recently published
results used on a particular population;
5) subject groups consisted of adult
women, i.e., 18-89 yr of age;
6)O2 max
values obtained by using objective criteria (23);
7) maximal exercise protocols
performed either on treadmills or cycle ergometers; and
8) only healthy subject populations.
A list of papers included in the meta-analysis can be obtained from the
authors on request.
3 sessions/wk) of vigorous
endurance exercise (e.g., running, cycling, swimming, rowing,
cross-country skiing) for 1 yr; 2)
active, referring to occasional or irregular performance (
2
sessions/wk) of aerobic exercise (walking, basketball, dancing, stairmaster exercise, etc.); and 3)
sedentary, referring to no performance of aerobic exercise.
O2 max and maximal
heart rate values.
O2 max , age, and
body weight on all groups. Maximal heart rate values were missing in
10-15% of the subject groups; therefore, for this variable,
analyses were performed on the available database only.
Linear regression analyses were performed to determine the association
among variables. In all cases, age was used as the predictor variable.
Pearson's product-moment correlation coefficients were used to
indicate the magnitude and direction of relations among variables.
One-way analysis of variance was used to determine differences in the
dependent variables (e.g., percent and absolute decline in
O2 max) among
populations (sedentary, active, and endurance-trained). When overall
significance was indicated, the Tukey's honestly significant
difference method for multiple comparisons was used to differentiate
among the three group means. All data were reported as
pooled means ± SD. The statistical significance level was set at
P < 0.05 (2-sided tests) for all
analyses.
RESULTS
Mean descriptive data for the three subject populations are shown in
Table 1. A total of 239 groups (4,884 subjects) and 109 studies met the criteria for inclusion. There were 63 groups (n = 911) in the
endurance-trained category, 69 groups
(n = 1,717) in the active category,
and 107 groups (n = 2,256) in the
sedentary category. Mean age was 5-7 yr greater in the sedentary
women compared with the two physically active populations. Body mass
was ~4 kg less in the endurance-trained vs. the active and sedentary
populations. As would be expected given our subject selection criteria,
O2 max was
lowest in the sedentary women, somewhat higher in the active women, and
highest in the endurance-trained women.
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O2 max with age.
O2 max was strongly
inversely related to age in each of the three populations
(r = 0.82 to 0.87, all
P < 0.0001; Fig. 1). The rate of decline in
O2 max with increasing
subject group age was lowest in the sedentary women (3.5
ml · kg1 · min1 · decade1), somewhat
greater in the active women (4.4
ml · kg1 · min1 · decade1),
and greatest in the endurance-trained women (6.2
ml · kg1 · min1 · decade1)
(all P < 0.001 vs. each other, Fig.
2, Fig.
3A, Table
2). In contrast, the rate of
decline in O2 max when
expressed as percent decrease from mean levels at age ~25 yr was
similar among the three subject populations (10.0 to
10.9%/decade; Table 2, Fig. 3B). Relatively few values for
O2 max were available
beyond 65 and 70 yr of age, respectively, for the endurance-trained and active populations (Fig. 1, A and
B). To account for this potential influence, the analysis also was performed by using 60 and 70 yr of
mean subject group age as end points. These analyses
provided the same results as did the original analysis.
O2 max) and subject
group age. A: endurance trained.
B: active.
C: sedentary. O2 max was
strongly inversely correlated with age in each of the 3 study
populations.
O2 max with increasing
subject group age in the 3 study populations. Rate of decline was
smallest in sedentary women and greatest in endurance-trained women.
O2 max given in
ml · kg1 · min1 · decade1
(A) and %/decade
(B) in the 3 study populations. The
ml · kg1 · min1 · decade1
rates of decline are increasingly greater from sedentary to active to
endurance trained (all P < 0.001 vs.
each other). In contrast, %/decade decreases from mean values at age
~25 yr were not different among the 3 populations.
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0.89 to 0.91, all P < 0.001; Fig. 4). In contrast to the absolute
declines in O2 max,
however, the corresponding declines in maximal heart rate were not
different in the three populations (7.0 to 7.9 beats · min1 · decade1).
Maximal heart rate was correlated with
O2 max in the each of
the three populations (r = 0.75-0.85, all P < 0.0001),
explaining 73, 56, and 71% of the variance in the sedentary, active,
and endurance-trained subjects, respectively.
DISCUSSION
At least two important new findings were generated by the present
investigation concerning the relationship between habitual aerobic
exercise status and the rate of decline in maximal aerobic capacity
with adult aging. First, in marked contrast to current theory based
primarily on data in men (8, 11, 12), our results indicate that the
rate of decline in
O2 max with increasing age is greater in endurance-trained women than in sedentary women. Specifically, we observed a direct, not inverse, relationship between
habitual aerobic exercise levels and the rate of decline in
O2 max with age across
our three subject populations. Second, the present data indicate
that there is no discernible relation between the rate of decline in
maximal heart rate with advancing age in healthy women and their
aerobic exercise status. Thus both of our working hypotheses were
refuted by the present findings.
O2 max with age.
Only a modest amount of data exists in women concerning the
relationship between aerobic exercise levels and the rate of decline in
O2 max with age. In
their classic 1987 review on
O2 max and aging,
Buskirk and Hodgson (4) summarized the results of several studies in
women (their Table 3, p. 1826). No consistent relationship was
demonstrated between the habitual exercise status of the population and
the associated rate of decline in
O2 max with age.
However, at least four independent lines of evidence support the
present findings of a greater rate of decline in
O2 max with age in
highly active vs. sedentary women. In a previous cross-sectional study,
Wells and colleagues (25) reported a rate of decline in
O2 max with age in
female distance runners (aged 35-70 yr) of 4.7
ml · kg1 · min1 · decade1,
which is much greater than that generally reported for sedentary women
(see next paragraph). This is approximately the same high rate of decline that Astrand et al. (1) reported in a longitudinal investigation of active female physical education teachers who were
studied ~20 yr apart. Moreover, in our recent cross-sectional study
(6) of highly trained female distance runners (aged 23-56 yr) who
were matched for age-adjusted performance,
O2 max was 12.3 ml · kg1 · min1
lower in runners with a mean age of 52 yr vs. those with a mean age of
30 yr, corresponding to a decline of 5.6
ml · kg1 · min1 · decade1.
Finally, a chapter by Smith and Gilligan in a larger government publication (22) contained a cross-sectional analysis of data on
O2 max women aged
~18-80 yr taken from published studies up to the year 1987. No
methods, results, or specific conclusions were presented. The
scatterplot of their data and the accompanying legend (their Fig. 3, p.
297) describe the slopes of the declines in
O2 max with age in
"active" vs. "sedentary" women as not significantly
different. However, the slope of the regression line for their active
women was ~22% greater than that for the sedentary women, which is
similar to the difference observed in the active vs. sedentary
populations in the present study.
During the development of the present manuscript, the results of a
cross-sectional analysis of 409 healthy women aged 20-64 yr by
Jackson and colleagues (13) were published. The analysis concerned the
relationship between self-report physical activity levels, body
fatness, and their interaction on the rate of decline in
O2 max with
age. Although the rates of decline in
O2 max across age
groups for each of their four self-report physical activity
classifications were not presented, calculations based on their mean
data (their Table 4, p. 887) indicate similar rates of decline among
the four groups at any particular level of body fatness. One
explanation for the apparent difference in these results and those of
the present study is the high rate of decline in
O2 max with age
reported for their sedentary subjects (5.4 ml · kg1 · min1 · decade1).
This is much greater than the respective rates for sedentary women
reported by Buskirk and Hodgson (4) (range 2.8 to 3.5 ml · kg1 · min1 · decade1), by Smith and
Gilligan (22) (3.0
ml · kg1 · min1 · decade1),
and in the present study (3.5 ml · kg1 · min1 · decade1)
(Figs. 1, 2, 3) and would effectively preclude the ability to show
differences from highly active women.
The prevailing concept of a smaller rate of decline in maximal aerobic
capacity with age in regularly exercising/endurance-trained compared
with sedentary individuals (8, 11, 12) is logical based on our
understanding of the physiological adaptations to regular exercise and
is certainly attractive from a "preventive gerontology"
standpoint. However, an argument also can be made for
hypothesizing greater rates of decline in
O2 max with age in
endurance exercise-trained adults.
The first argument involves a baseline effect, i.e., the law of initial
baseline applied to
O2 max. Stated simply,
according to this concept those individuals with the highest levels of
O2 max as young adults
should demonstrate the greatest rates of decline with advancing age.
Support for this idea is provided by our data on the "relative"
rates of decline in
O2 max. Specifically, when this baseline effect is removed by expressing the data as percent
change from mean levels at age ~25 yr, the rates of decline in
O2 max with age in the
endurance-trained, active, and sedentary women are
similar. It is interesting (and possibly instructive) that a similar relationship exists in the age-related rates of decline
in O2 max in men vs.
women. Men have higher levels of O2 max as young adults
compared with women but demonstrate a greater absolute rate of decline
in O2 max with age
compared with women based on cross-sectional data (4, 22). When
expressed as percent change, however, gender-related differences are no longer evident.
The second argument involves declines in habitual aerobic exercise
levels with advancing age. Studies of male endurance athletes indicate
that training volumes of older athletes often are up to 50% lower than
those of their young adult colleagues (5, 15, 19). In our recent study
(6), female distance runners matched for age-adjusted performance,
weekly training mileage was 45% lower in women runners with a mean age
of 52 yr vs. that for runners with a mean age of 30 yr; weekly training
frequency and running velocity also were lower in the older
runners. In the present meta-analysis, weekly running
mileage was reported for 25 subject groups in 14 studies. The data are
plotted in Fig. 5 and reveal a progressive,
significant age-related decline. Based on the regression line from this
sample, running mileage would be expected to decline from ~90 km/wk
at age 20 yr to <30 km/wk at age 70 yr, a decrease in excess of 65%.
These observations support the view that overall aerobic exercise
levels decline markedly with age in endurance-trained adults. Because
sedentary young adults, by definition, are not performing regular
aerobic exercise, it follows that the magnitude of decline in the
intensity, duration, and frequency of aerobic exercise with age, which
collectively have a strong influence on
O2 max (17), is much
greater in regularly exercising individuals. Thus this greater decrease
in the overall exercise stimulus for maintaining maximal aerobic capacity could contribute to a greater rate of decline in
O2 max with age in
exercise-trained vs. sedentary adults.
Finally, because
O2 max
is traditionally expressed in units corrected for differences in body
weight, it is possible that greater increases in body weight with age
in the exercising groups contributed to their greater rates of
decline in maximal aerobic capacity in the present study. This would
appear to be a reasonable possibility in that young adults who perform
aerobic exercise on a regular basis demonstrate lower levels of body
weight due to lower body fatness compared with their sedentary
peers and, therefore, might tend to gain more weight with age as they
undergo a greater decline in exercise-related energy
expenditure. This does not appear, however, to have
played a role in the results of the present study. Body weight
increased with age within each of our populations (all
P < 0.01), but the slopes of
regression lines representing the respective rates of increases were
not different from each other.
Age-related rate of decline in maximal heart rate.
Because maximal heart rate is considered to be an important determinant
of age-related decline in
O2 max (10,
16, 19), the question has been raised as to whether the greatest
declines in O2 max with
age are associated with the largest reductions in maximal heart rate
(8, 10, 11). The present findings indicate that there is no obvious
relationship between age-related declines in
O2 max and
maximal heart rate in women differing widely in habitual aerobic
exercise status. The data from the aforementioned analysis of Smith and
Gilligan (22), as well as the earlier findings of Astrand et al. (1),
support this observation. Taken together, these findings suggest that
other factors (e.g., declines in maximal stroke volume or skeletal
muscle oxidative capacity) were responsible for differences in the
absolute rates of decline in
O2 max observed in the
exercising vs. sedentary populations in the present study.
Physiological significance and study limitations.
The present finding that the absolute rate of decline in
O2 max with
advancing age is directly related to aerobic exercise status suggests
that the rate of loss of physiological functional capacity with age, at
least that which depends on maximal aerobic power, would be greater in
endurance-trained vs. sedentary women. Thus, from their high levels of
functional capacity as young adults, exercise-trained women may
experience greater absolute reductions over the normal life span.
We wish to emphasize, however, that despite their apparent greater rate
of decline in O2 max at
any age, women who regularly engage in aerobic exercise demonstrate
significantly higher absolute levels of maximal aerobic capacity than
do their sedentary peers. Therefore, on average,
exercise-trained women enjoy a higher level of physiological functional
capacity throughout adult aging compared with sedentary women. This
means that endurance-trained females are able to perform physical tasks
that cannot be performed by their sedentary peers (or would require a
much greater effort and percentage of their physiological reserve).
The major limitation of the present investigation is its
cross-sectional design. A longitudinal approach in which the same subjects are studied over their entire adult life span, theoretically, would provide more definitive insight into this issue. Saltin (21) has
demonstrated that the average rate of decline in
O2 max with advancing
age in endurance athletes is similar whether they are studied
cross-sectionally or longitudinally. Despite this finding, however, it
is important to appreciate that the cross-sectional nature of the
present study could have produced results that are different from those
that would have been obtained from a longitudinal approach.
Finally, we recognize that it has been demonstrated that maximal
aerobic capacity can be maintained over 10- to 20-yr periods in
middle-aged men who are able to sustain their levels of aerobic exercise training (14, 18). The present findings are not in conflict
with these previous observations in any way. Rather, our results
support the hypothesis that on average the absolute rate of decline in
O2 max in
endurance-trained women as a whole is greater than that observed in
less active women when viewed over the normal adult life span. As
discussed previously, this may be due in part to a progressive and,
ultimately, substantial reduction in their exercise habits with
advancing age.
Conclusions.
The results of the present study provide experimental support for the
idea that the rate of decline in maximal aerobic capacity with age in
healthy women is greatest in endurance-trained women and least in
sedentary women, contrary to the currently accepted view. The greater
rate of decline in
O2 max in highly active women may be due to their high baseline levels as young adults and/or to greater reductions in their exercise levels with
advancing age compared with sedentary women. Our findings also
fail to provide evidence that the level of habitual aerobic exercise
is related to the rate of decline in maximal heart rate with age.
ACKNOWLEDGEMENTS
This study was supported by National Institutes of Health (NIH) RO1 Awards AG-06537, AG-13038, and HL-39966. H. Tanaka was supported by NIH Individual National Research Service Award AG-05717.
FOOTNOTES
Address for reprint requests: D. R. Seals, Univ. of Colorado, Dept. of Kinesiology, Campus Box 354, Boulder, CO 80309 (E-mail: Seals{at}spot.Colorado.edu).
Received 16 September 1996; accepted in final form 12 March 1997.
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 S. K. Hunter, A. Critchlow, and R. M. Enoka Muscle endurance is greater for old men compared with strength-matched young men J Appl Physiol, September 1, 2005; 99(3): 890 - 897. [Abstract] [Full Text] [PDF]
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 P. A. Ades and M. J. Toth Accelerated Decline of Aerobic Fitness With Healthy Aging: What Is the Good News? Circulation, August 2, 2005; 112(5): 624 - 626. [Full Text] [PDF]
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J. L. Fleg, C. H. Morrell, A. G. Bos, L. J. Brant, L. A. Talbot, J. G. Wright, and E. G. Lakatta Accelerated Longitudinal Decline of Aerobic Capacity in Healthy Older Adults Circulation, August 2, 2005; 112(5): 674 - 682. [Abstract] [Full Text] [PDF]
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H. B Rossiter, R. A Howlett, H. H Holcombe, P. L Entin, H. E Wagner, and P. D Wagner Age is no barrier to muscle structural, biochemical and angiogenic adaptations to training up to 24 months in female rats J. Physiol., June 15, 2005; 565(3): 993 - 1005. [Abstract] [Full Text] [PDF]
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S. K. Hunter, A. Critchlow, and R. M. Enoka Influence of aging on sex differences in muscle fatigability J Appl Physiol, November 1, 2004; 97(5): 1723 - 1732. [Abstract] [Full Text] [PDF]
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 C. Hung, B. Daub, B. Black, R. Welsh, A. Quinney, and M. Haykowsky Exercise Training Improves Overall Physical Fitness and Quality of Life in Older Women With Coronary Artery Disease Chest, October 1, 2004; 126(4): 1026 - 1031. [Abstract] [Full Text] [PDF]
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L. Stathokostas, S. Jacob-Johnson, R. J. Petrella, and D. H. Paterson Longitudinal changes in aerobic power in older men and women J Appl Physiol, August 1, 2004; 97(2): 781 - 789. [Abstract] [Full Text] [PDF]
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S. A. Spier, M. D. Delp, C. J. Meininger, A. J. Donato, M. W. Ramsey, and J. M. Muller-Delp Effects of ageing and exercise training on endothelium-dependent vasodilatation and structure of rat skeletal muscle arterioles J. Physiol., May 1, 2004; 556(3): 947 - 958. [Abstract] [Full Text] [PDF]
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 A Romberg, A Virtanen, S Aunola, S-L Karppi, H Karanko, and J Ruutiainen Exercise capacity, disability and leisure physical activity of subjects with multiple sclerosis Multiple Sclerosis, April 1, 2004; 10(2): 212 - 218. [Abstract] [PDF]
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H. Tanaka and D. R. Seals Invited Review: Dynamic exercise performance in Masters athletes: insight into the effects of primary human aging on physiological functional capacity J Appl Physiol, November 1, 2003; 95(5): 2152 - 2162. [Abstract] [Full Text] [PDF]
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A. E. Pimentel, C. L. Gentile, H. Tanaka, D. R. Seals, and P. E. Gates Greater rate of decline in maximal aerobic capacity with age in endurance-trained than in sedentary men J Appl Physiol, June 1, 2003; 94(6): 2406 - 2413. [Abstract] [Full Text] [PDF]
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S. Welle, K. Bhatt, B. Shah, N. Needler, J. M. Delehanty, and C. A. Thornton Reduced amount of mitochondrial DNA in aged human muscle J Appl Physiol, April 1, 2003; 94(4): 1479 - 1484. [Abstract] [Full Text] [PDF]
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 J. M. Muller-Delp, S. A. Spier, M. W. Ramsey, and M. D. Delp Aging impairs endothelium-dependent vasodilation in rat skeletal muscle arterioles Am J Physiol Heart Circ Physiol, October 1, 2002; 283(4): H1662 - H1672. [Abstract] [Full Text] [PDF]
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I. Eskurza, A. J. Donato, K. L. Moreau, D. R. Seals, and H. Tanaka Changes in maximal aerobic capacity with age in endurance-trained women: 7-yr follow-up J Appl Physiol, June 1, 2002; 92(6): 2303 - 2308. [Abstract] [Full Text] [PDF]
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B. C. Schiller, Y. G. Casas, C. A. Desouza, and D. R. Seals Maximal aerobic capacity across age in healthy Hispanic and Caucasian women J Appl Physiol, September 1, 2001; 91(3): 1048 - 1054. [Abstract] [Full Text] [PDF]
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 H. Tanaka, K. D. Monahan, and D. R. Seals Age-predicted maximal heart rate revisited J. Am. Coll. Cardiol., January 1, 2001; 37(1): 153 - 156. [Abstract] [Full Text] [PDF]
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T. M. Wilson and H. Tanaka Meta-analysis of the age-associated decline in maximal aerobic capacity in men: relation to training status Am J Physiol Heart Circ Physiol, March 1, 2000; 278(3): H829 - H834. [Abstract] [Full Text] [PDF]
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H. Tanaka, C. A. Desouza, P. P. Jones, E. T. Stevenson, K. P. Davy, and D. R. Seals Greater rate of decline in maximal aerobic capacity with age in physically active vs. sedentary healthy women J Appl Physiol, December 1, 1997; 83(6): 1947 - 1953. [Abstract] [Full Text] [PDF]
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ABSTRACT
