Right Heart Cardiac Magnetic Resonance Profiles and Cardiopulmonary Reserve in Older Adults Undergoing Long-Term Multicomponent Exercise: A 2-Year Longitudinal Study.
Liu T, Song Y, et al. • Scandinavian journal of medicine & science in sports • 2026
Long-term multicomponent exercise was associated with higher levels of selected right heart volumetric and functional measures without detectable alterations in longitudinal cardiac remodeling trajectories in older adults, alongside favorable longitudinal changes in cardiopulmonary reserve.
Key Findings
Results
No significant time × group interactions were detected for right or left heart parameters over 2 years of follow-up.
All time × group interaction p-values were > 0.05 for right and left heart parameters
This indicates that the longitudinal trajectories of cardiac structural remodeling did not differ significantly between exercise and control groups
Study used cardiac magnetic resonance imaging (CMR) at baseline, 1-year, and 2-year follow-ups
92 participants completed the 2-year follow-up (training: n=54; control: n=38) out of 155 originally assigned
Results
After multivariable adjustment, the exercise group showed higher overall adjusted mean values for right atrial volumes and selected right ventricular functional measures.
Specific right ventricular measures that were higher in the exercise group included stroke volume, cardiac index, and peak filling rate (all p < 0.05)
Right atrial volumes were also higher in the exercise group after adjustment (p < 0.05)
These differences reflect higher overall adjusted mean levels rather than diverging longitudinal trajectories
Participants were aged ≥65 years assigned to supervised multicomponent training (n=75) or education control (n=80)
Results
Significant time × group interactions were identified for peak VO2 and VO2 at anaerobic threshold, indicating distinct longitudinal cardiopulmonary trajectories between groups.
Time × group interaction for peak VO2: p = 0.003
Time × group interaction for VO2 at anaerobic threshold (AT): p = 0.033
These findings indicate that cardiopulmonary reserve followed different longitudinal trajectories in the exercise versus control group
Cardiopulmonary exercise testing (CPET) was performed at baseline, 1-year, and 2-year follow-ups
Results
Post hoc subgroup analyses showed that between-group differences in right heart volumetric measures persisted through 2 years in the high-adherence group but were less consistent in the low-adherence group.
Post hoc analyses were stratified by training adherence (high-adherence vs. low-adherence subgroups)
High-adherence participants maintained between-group differences in right heart volumetric measures through the full 2-year period
Low-adherence participants showed less consistent between-group differences in right heart volumetric measures
This suggests a dose-response relationship between exercise adherence and right heart adaptation
Methods
The study design was a prospective, non-randomized, two-armed cohort study with an interim analysis at 2 years.
155 adults aged ≥65 years were assigned to supervised multicomponent training (n=75) or education control group (n=80)
The study was registered at ChiCTR2000032404, registered on April 27, 2020
Primary outcomes were right heart structure and function measured by cardiac magnetic resonance imaging
92 of 155 participants (59%) completed the 2-year follow-up and were included in the final analysis
The study was non-randomized, which is a key methodological limitation
Conclusions
The authors concluded that exercise-related benefits in healthy aging may be characterized primarily by functional adaptations rather than longitudinal structural cardiac remodeling.
Despite higher adjusted mean values for selected right heart measures in the exercise group, no significant time × group interactions for cardiac structural parameters were found
Favorable longitudinal changes in cardiopulmonary reserve (peak VO2 and VO2 at AT) were observed with exercise
The pattern suggests that functional, rather than structural, cardiac adaptation characterizes the exercise response in older adults
Right heart geometry and function are described as essential for preserving physical performance in healthy aging
What This Means
This research suggests that older adults (age 65 and over) who participate in long-term, supervised multicomponent exercise programs (combining different types of exercise) for up to two years show improvements in certain measures of heart and lung fitness compared to a control group that received only education. Specifically, the exercise group had higher values for measures of how the right side of the heart fills and pumps blood, and they showed distinctly better trajectories in cardiorespiratory fitness (how efficiently the body uses oxygen during exercise) over the two-year period. However, the overall shape and size of the heart did not change differently between groups over time, suggesting the heart did not undergo major structural remodeling in response to exercise.
The study also found that how consistently participants stuck to their exercise program mattered: those with higher adherence showed more sustained differences in right heart volume measures compared to those with lower adherence, suggesting a dose-response relationship. The study included 155 older adults, though only 92 completed the full two years of follow-up, and it was not a randomized trial, which are important limitations to keep in mind when interpreting the findings.
This research suggests that the heart-related benefits of regular exercise in older age may come primarily from improvements in how the heart functions—such as how well it pumps blood and how efficiently the body uses oxygen—rather than from changes in the physical size or structure of the heart. This has potential implications for understanding how exercise programs should be designed and maintained for older adults to support healthy cardiovascular aging.
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Liu T, Song Y, Ye Z, Jiang C, Cheng Y, Dai Y, et al.. (2026). Right Heart Cardiac Magnetic Resonance Profiles and Cardiopulmonary Reserve in Older Adults Undergoing Long-Term Multicomponent Exercise: A 2-Year Longitudinal Study.. Scandinavian journal of medicine & science in sports. https://doi.org/10.1111/sms.70368