Decline in cardiorespiratory fitness and its association with vascular aging and subclinical atherosclerosis in healthy older adults: a 3-year longitudinal study

Aging is associated with progressive deterioration of vascular function and cardiovascular risk. Cardiorespiratory fitness (CRF) is closely associated with cardiovascular health, yet longitudinal data in healthy older adults remain limited. This study examined 3-year changes in vascular and echocardiographic parameters in older adults and their associations with CRF and muscle strength. Forty-nine participants (mean age 63.8 ± 3.8 years) underwent vascular assessments (brachial/central blood pressure (BP), pulse wave velocity (PWV), augmentation index), echocardiography, CRF testing via spiroergometry to determine VO 2 peak, muscle strength testing, and carotid sonography at baseline and after 3 years. Participants were grouped by carotid plaque status: no atherosclerosis, existing atherosclerosis, or newly developed atherosclerosis. Over 3 years, CRF and muscle strength (grip strength, leg flexion) declined significantly (all p < 0.005), while systolic BP ( p = 0.042), brachial-ankle PWV ( p = 0.006), and echocardiographic parameters including aortic root diameter and ventricular dimensions increased (all p < 0.001). Participants with newly developed atherosclerosis showed the greatest CRF decline ( p = 0.012). Changes in CRF were inversely associated with changes in systolic, diastolic, and central BP (all p < 0.01). Declines in leg flexion strength were also linked to larger BP increases. Participants maintaining > 90% of baseline VO 2 peak had significantly smaller BP increases. These results indicate that vascular aging progresses measurably within a few years in clinically healthy older adults and is associated with declines in CRF and muscle strength. Preservation of CRF is linked to more favorable vascular aging profiles and a lower prevalence of newly developed atherosclerosis.