Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 172

Dose‐response relationships between changes in fitness and better health outcomes have been defined for some, but certainly not all, diseases and syndromes. Some modalities or doses of exercise promoted for older adults (mild callisthenics, slow‐paced walking) have little or no discernible effects on physical fitness but may yield benefits in some domains. This area of investigation is critical for defining threshold and optimal levels of activity that are necessary for health promotion and disease management. It should be recognised that what is suitable for prevention may be entirely inadequate for treatment, as is also the case with pharmacological management of chronic diseases. For example, aspirin may reduce the risk of ischaemic heart disease, but a host of potent agents and surgery may be required once coronary occlusive disease is present and symptomatic.

Dose‐response heterogeneity is not unique to pharmaceutical therapies.²⁵ In the era of precision medicine, interindividual variability in the magnitude of response to supervised exercise training (subject‐by‐training interaction or individual response) has received increasing scientific interest in both adults and children.^26‐31 For instance, some individuals show improvements with exercise training (e.g., decrease in fasting glucose) and are considered responders, whereas others may not have such a response (e.g., no change or even increases in fasting glucose) and are considered non‐responders.³² A physiological non‐response to exercise in one outcome does not signify a non‐response in all outcomes. Exercise and medical researchers have recognised the substantial variability in patient response to physical exercise interventions and have sought to understand these differences. Individual interaction of physiological, molecular (i.e., genetics, epigenetics, transcriptomics, and metabolic factors), and environmental factors are being investigated as potential mediators of the lack of a response to exercise in some participants.³³