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Twenty-six physiological parameters to assess aging

Article
June 26, 2022
By
Ehab Naim, MBA.

The aging process causes a decline in the overall body function. There are physiological parameters that could help establish how far aging has impacted the body to capture these changes.

Twenty-six physiological parameters to assess aging

Highlights:

  • The aging process causes structural and functional changes in different organs and systems
  • Physiological measures are parameters that are used to assess the changes taking place in various organs and systems
  • The aging process influences many physiological parameters, causing most of them to decline as organs function decreases with time

Introduction

Physiological aging involves the progressive decline in organ and/or system function. Examples of the latter include neurological, pulmonary, cardiovascular, musculoskeletal, and other systems. The speed of function decline varies among individuals and organs themselves. They are attributed to reasons like genetics, environment, and developmental factors. Since there is an intra- and inter-individual variability in terms of physiological function, assessing these changes will help determine the extent of the decline in organs’ functional capacity. Collectively, these measures provide an idea about how the aging process impacts the overall health of individuals and guide interventions to combat age-related changes.

Image 1

Cardiovascular physiological measurements

The cardiovascular system is perhaps one of the most well-studied systems impacted by the aging process. In this context, research has shown that the cardiovascular system undergoes structural and functional changes due to aging (1). Examples of structural changes include increased vascular stiffness, ventricular thickness, and atrial size (2). These changes occur due to reduced elasticity, increased left atrial pressure, and other causes. The outcome is an increased risk of atherosclerosis, hypertension, stroke, and arrhythmia (2). Functional changes involve reduced nitric oxide production (supports many biological actions, like blood vessels widening) and reduced threshold for cell calcium overload (lower arrhythmia threshold and increased risk of myocyte death).

Several physiological parameters could be utilized to understand the impact of aging on the cardiovascular system. They are illustrated in the table below (3).

Functional parameter

Definition

Heart rate variability (HRV)

It is the fluctuation in time intervals between heartbeats. It decreases with aging, leading to an increased risk of coronary heart disease and mortality (4, 5).

Aortic valve calcification

A progressive condition characterized by the formation of calcium deposits on the aortic heart valve (6).

Augmentation index

It is the difference between the first and second peaks of the central arterial waveform. It is an indirect measure of systemic arterial stiffness. It increases with age (7).

Left ventricular mass

It is a strong predictor of adverse cardiovascular events. This parameter increases with age (8, 9).

Brachial pulse pressure

It is the difference between systolic and diastolic blood pressure. It increases with age and is an established marker of cardiovascular diseases (10).

Pulse-wave velocity

A clinically useful indicator of arterial stiffness. It is the speed at which pressure waves generated from systolic contractions move through the arteries (11).

 

Assessing the aging impact on pulmonary function

Lung function is a reliable physiological marker of aging. The literature indicates that aerobic capacity decreases by more than 20% per decade after 70 years (3). In the same context, research shows that the aging process alters the structure and function of the lung and supportive parts, like the chest wall and respiratory muscles (12). These changes trigger unfavorable lung mechanisms associated with increased air trapping, reduced gas exchange, and decreased expiratory airflow.

Lung function testing represents a helpful tool that determines the aging impact on the respiratory tract. The table below captures physiological pulmonary tests that could help assess lung health and how aging has impacted it (3, 13-22).

Functional parameter

Definition

Peak aerobic capacity (VO2Peak)

Is the person’s capacity to maximize oxygen use while performing physical activity. It declines as individuals age. It decreases by 3-6% in the third and fourth decades of life.

Spirometry (FEV1, FVC, FEV1/FVC ratio)

A common pulmonary test that assesses fitness and monitors lung function. According to research, lung function declines with age.

Lung volumes (TLC, FRC, RV)

Lung volumes help monitor lung health over time. Changes in these volumes start to appear after the age of 35. For example, FRC increases with age due to reduced lung elasticity, making air harder to expel. RV and TLC also increase due to aging.

Diffusing capacity for carbon monoxide

It measures the lung's capacity to transfer carbon monoxide from inspired air into the bloodstream. It decreases with aging, but maintaining a healthy lifestyle and exercising could ease the decline.

Quantitative ventilation-perfusion scanning

It is an established parameter for lung function. The mismatch between ventilation/perfusion increases with age due to airway closure in certain parts of the lung.

FEV1: Forced expiratory volume in the first second; FVC: Forced vital capacity; TLC: Total lung capacity; FRC: Functional residual capacity; RV: Residual volume.

Image 2

Physiological measurements to assess the age-related impact on renal function

Under normal conditions, the kidneys are highly metabolic organs that are impacted by aging. According to the literature, the kidneys undergo structural and functional changes due to aging (23). For example, research highlights that kidney mass changes by up to 25% between the third and eighth decades of life. Nephrosclerosis (hardening of the wall lining small arteries and arterioles supplying the kidney), a hallmark of kidney aging, will cause the loss of up to 6500 nephrons (the structural and functional unit of the kidney. Each kidney has an average of 900,000 to 1 million nephrons) per year after the age of 30 (3, 23, 24). Also, the glomerular filtration rate (GFR) (a biomarker showing kidneys' filtration capacity or how well they work) falls by about 5–10 % per decade after the age of 35 years (23).

Several tests could be utilized to assess the impact of aging on renal function. They are listed below (3, 25).

Functional parameter

Definition

Creatinine clearance

It is the volume of plasma cleared of creatinine per time unit. Research shows that it declines with age.

Glomerular filtration Rate (GFR)

A test that is used to detect how well the kidneys function. Glomeruli are kidney structures that remove waste. GFR decreases with age.

 

Musculoskeletal system and physiological markers

Like other bodily systems, multiple players in the musculoskeletal system are affected by aging. For example, skeletal muscle mass and strength decline with aging (26). Also, tendons, bones, and cartilages are impacted by age.

There are several parameters that could be assessed to determine the overall impact of age on the musculoskeletal system. They are summarized in the following table (3, 27-31).

Functional parameter

Definition

Grip strength

A measure that is widely adopted as a useful indicator of overall strength. In addition to measuring grip strength, it assesses upper limb function, bone mineral density, presence of comorbidities, and others.

Unipedal stance test of balance

It is a test that is used to assess postural balance.

Grooved pegboard test of fine motor coordination

It is a test that measures fine-motor task speed on both sides of the body.

SF-36 physical functioning scale

A questionnaire that evaluates the overall quality of life by incorporating several measures, including physical functioning.

Gait speed

The walking test could serve as a subjective estimator of general health and skeletal muscle mass.

SF: Short form.

Image 3

Other physiological measurements

In addition to the measurements listed above, other systems and bodily functions are impacted by aging. Examples include the immune system, neurocognitive function, integumentary (skin and appendages) system, and sensory system (3).

The table below compiles a number of physiological measures that could help understand the impact of aging on different body parts by assessing these parameters (3, 32-41).

Functional parameter

Definition

Immune risk profile (immune system)

It assesses a cluster of parameters, including proteins CD4, CD8, CD19, and others. Elevations of this profile are associated with functional limitations and mortality in the elderly.

Mini-mental status examination (neurocognitive)

A test that is used to detect cognitive impairment. Research shows that test scores decrease with age.

Cognitive battery (neurocognitive)

It is a test that assesses key cognitive abilities, like attention, memory, and verbal fluency.

Visual acuity (sensory)

A test based on a chart containing 11 lines, with each line including letters of various sizes.

Auditory tests (sensory)

These are tests that assess age-related hearing loss.

Skin elasticity tests (integumentary system)

Tests to assess skin elasticity. They help identify age-related changes occurring to the skin. The literature indicates that skin elasticity decreases with aging.

Skin thickness (integumentary system)

Tests carried out to determine skin thickness, as research shows that it decreases with age.

Wrinkle parameters measurement (integumentary system)

Wrinkles increase due to multiple factors associated with aging, like collagen loss. Measuring wrinkles could help determine the impact of aging on the skin.

Conclusions

The aging process carries many changes to different body organs and systems. Research has established that the aging process causes a decline in the overall body function. There are physiological parameters that could help establish how far aging has impacted the body to capture these changes. Although these parameters may not be specifically established to understand the said impact, they provide a clear picture of how aging leads to changes in physiological parameters. Capturing and understanding the value of these physiological measurements could help establish how different biological age is from chronological age.

 

References

1.            North BJ, Sinclair DA. The intersection between aging and cardiovascular disease. Circulation research. 2012;110(8):1097-108.

2.            Strait JB, Lakatta EG. Aging-associated cardiovascular changes and their relationship to heart failure. Heart failure clinics. 2012;8(1):143-64.

3.            Khan SS, Singer BD, Vaughan DE. Molecular and physiological manifestations and measurement of aging in humans. Aging Cell. 2017;16(4):624-33.

4.            Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Frontiers in public health. 2017;5:258-.

5.            Jandackova VK, Scholes S, Britton A, Steptoe A. Are Changes in Heart Rate Variability in Middle-Aged and Older People Normative or Caused by Pathological Conditions? Findings From a Large Population-Based Longitudinal Cohort Study. Journal of the American Heart Association. 2016;5(2):e002365.

6.            Lerman DA, Prasad S, Alotti N. Calcific Aortic Valve Disease: Molecular Mechanisms and Therapeutic Approaches. European cardiology. 2015;10(2):108-12.

7.            Wilkinson IB, MacCallum H, Flint L, Cockcroft JR, Newby DE, Webb DJ. The influence of heart rate on augmentation index and central arterial pressure in humans. The Journal of physiology. 2000;525 Pt 1(Pt 1):263-70.

8.            Nethononda RM, McGurk KA, Whitworth P, Francis J, Mamasoula C, Cordell HJ, et al. Marked variation in heritability estimates of left ventricular mass depending on modality of measurement. Scientific Reports. 2019;9(1):13556.

9.            Stokar J, Leibowitz D, Durst R, Shaham D, Zwas DR. Echocardiography overestimates LV mass in the elderly as compared to cardiac CT. Plos one. 2019;14(10):e0224104.

10.          Verdecchia P, Angeli F. Does brachial pulse pressure predict coronary events? Atherosclerosis, Large Arteries and Cardiovascular Risk. 2007;44:150-9.

11.          Kang J, Han K, Hyung J, Hong G-R, Yoo Y. Noninvasive Aortic Ultrafast Pulse Wave Velocity Associated With Framingham Risk Model: in vivo Feasibility Study. Frontiers in Cardiovascular Medicine. 2022;9.

12.          Skloot GS. The Effects of Aging on Lung Structure and Function. Clin Geriatr Med. 2017;33(4):447-57.

13.          Gater DR. CHAPTER EIGHTEEN - Exercise and Fitness with Spinal Cord Injury. In: Sisto SA, Druin E, Sliwinski MM, editors. Spinal Cord Injuries. Saint Louis: Mosby; 2009. p. 430-54.

14.          Jakovljevic DG. Physical activity and cardiovascular aging: Physiological and molecular insights. Experimental Gerontology. 2018;109:67-74.

15.          Lamb K, Theodore D, Bhutta BS. Spirometry. 2020.

16.          Thomas ET, Guppy M, Straus SE, Bell KJL, Glasziou P. Rate of normal lung function decline in ageing adults: a systematic review of prospective cohort studies. BMJ Open. 2019;9(6):e028150.

17.          Lutfi MF. The physiological basis and clinical significance of lung volume measurements. Multidisciplinary Respiratory Medicine. 2017;12(1):3.

18.          Modi P, Cascella M. Diffusing capacity of the lungs for carbon monoxide. 2020.

19.          Coffman KE, Carlson AR, Miller AD, Johnson BD, Taylor BJ. The effect of aging and cardiorespiratory fitness on the lung diffusing capacity response to exercise in healthy humans. Journal of Applied Physiology. 2017;122(6):1425-34.

20.          Cardús J, Burgos F, Diaz O, Roca J, Barberà JA, Marrades RM, et al. Increase in pulmonary ventilation-perfusion inequality with age in healthy individuals. Am J Respir Crit Care Med. 1997;156(2 Pt 1):648-53.

21.          Green FHY, Pinkerton KE. Chapter 27 - Environmental Determinants of Lung Aging. In: Harding R, Pinkerton KE, editors. The Lung (Second Edition). Boston: Academic Press; 2014. p. 471-91.

22.          Powers KA, Dhamoon AS. Physiology, Pulmonary Ventilation and Perfusion. 2019.

23.          Fang Y, Gong AY, Haller ST, Dworkin LD, Liu Z, Gong R. The ageing kidney: Molecular mechanisms and clinical implications. Ageing research reviews. 2020;63:101151-.

24.          Bertram JF, Douglas-Denton RN, Diouf B, Hughson MD, Hoy WE. Human nephron number: implications for health and disease. Pediatr Nephrol. 2011;26(9):1529-33.

25.          Glassock RJ, Winearls C. Ageing and the glomerular filtration rate: truths and consequences. Transactions of the American Clinical and Climatological Association. 2009;120:419-28.

26.          Frontera WR. Physiologic Changes of the Musculoskeletal System with Aging: A Brief Review. Phys Med Rehabil Clin N Am. 2017;28(4):705-11.

27.          Bohannon RW. Grip Strength: An Indispensable Biomarker For Older Adults. Clinical interventions in aging. 2019;14:1681-91.

28.          Springer BA, Marin R, Cyhan T, Roberts H, Gill NW. Normative values for the unipedal stance test with eyes open and closed. Journal of geriatric physical therapy. 2007;30(1):8-15.

29.          Tolle KA, Rahman-Filipiak AM, Hale AC, Kitchen Andren KA, Spencer RJ. Grooved Pegboard Test as a measure of executive functioning. Applied Neuropsychology: Adult. 2020;27(5):414-20.

30.          Lins L, Carvalho FM. SF-36 total score as a single measure of health-related quality of life: Scoping review. SAGE open medicine. 2016;4:2050312116671725-.

31.          Kim H-J, Park I, Lee HJ, Lee O. The reliability and validity of gait speed with different walking pace and distances against general health, physical function, and chronic disease in aged adults. Journal of exercise nutrition & biochemistry. 2016;20(3):46-50.

32.          Caldeira M, Brunialti M, Salomão R, Mello Almada Filho C, Cendoroglo M. IMMUNE RISK PROFILE (IRP) AND MORBITY PHENOTYPE OF INDEPENDENT OLDEST OLD. Innovation in Aging. 2017;1(suppl_1):211-.

33.          Wikby A, Månsson IA, Johansson B, Strindhall J, Nilsson SE. The immune risk profile is associated with age and gender: findings from three Swedish population studies of individuals 20-100 years of age. Biogerontology. 2008;9(5):299-308.

34.          Bleecker ML, Bolla-Wilson K, Kawas C, Agnew J. Age‐specific norms for the mini‐mental state exam. Neurology. 1988;38(10):1565-.

35.          Rapp SR, Legault C, Espeland MA, Resnick SM, Hogan PE, Coker LH, et al. Validation of a cognitive assessment battery administered over the telephone. Journal of the American Geriatrics Society. 2012;60(9):1616-23.

36.          Jin J. Screening for Impaired Visual Acuity in Older Adults. JAMA. 2016;315(9):954-.

37.          Lycke M, Lefebvre T, Cool L, Van Eygen K, Boterberg T, Schofield P, et al. Screening Methods for Age-Related Hearing Loss in Older Patients with Cancer: A Review of the Literature. Geriatrics (Basel, Switzerland). 2018;3(3):48.

38.          Woo MS, Moon KJ, Jung HY, Park SR, Moon TK, Kim NS, et al. Comparison of skin elasticity test results from the Ballistometer(®) and Cutometer(®). Skin Res Technol. 2014;20(4):422-8.

39.          Kawałkiewicz W, Matthews-Kozanecka M, Janus-Kubiak M, Kubisz L, Hojan-Jezierska D. Instrumental diagnosis of facial skin-A necessity or a pretreatment recommendation in esthetic medicine. Journal of cosmetic dermatology. 2021;20(3):875-83.

40.          Farage MA, Miller KW, Elsner P, Maibach HI. Characteristics of the Aging Skin. Advances in wound care. 2013;2(1):5-10.

41.          Hatzis J. The wrinkle and its measurement--a skin surface Profilometric method. Micron. 2004;35(3):201-19.

 

Twenty-six physiological parameters to assess aging

Highlights:

  • The aging process causes structural and functional changes in different organs and systems
  • Physiological measures are parameters that are used to assess the changes taking place in various organs and systems
  • The aging process influences many physiological parameters, causing most of them to decline as organs function decreases with time

Introduction

Physiological aging involves the progressive decline in organ and/or system function. Examples of the latter include neurological, pulmonary, cardiovascular, musculoskeletal, and other systems. The speed of function decline varies among individuals and organs themselves. They are attributed to reasons like genetics, environment, and developmental factors. Since there is an intra- and inter-individual variability in terms of physiological function, assessing these changes will help determine the extent of the decline in organs’ functional capacity. Collectively, these measures provide an idea about how the aging process impacts the overall health of individuals and guide interventions to combat age-related changes.

Image 1

Cardiovascular physiological measurements

The cardiovascular system is perhaps one of the most well-studied systems impacted by the aging process. In this context, research has shown that the cardiovascular system undergoes structural and functional changes due to aging (1). Examples of structural changes include increased vascular stiffness, ventricular thickness, and atrial size (2). These changes occur due to reduced elasticity, increased left atrial pressure, and other causes. The outcome is an increased risk of atherosclerosis, hypertension, stroke, and arrhythmia (2). Functional changes involve reduced nitric oxide production (supports many biological actions, like blood vessels widening) and reduced threshold for cell calcium overload (lower arrhythmia threshold and increased risk of myocyte death).

Several physiological parameters could be utilized to understand the impact of aging on the cardiovascular system. They are illustrated in the table below (3).

Functional parameter

Definition

Heart rate variability (HRV)

It is the fluctuation in time intervals between heartbeats. It decreases with aging, leading to an increased risk of coronary heart disease and mortality (4, 5).

Aortic valve calcification

A progressive condition characterized by the formation of calcium deposits on the aortic heart valve (6).

Augmentation index

It is the difference between the first and second peaks of the central arterial waveform. It is an indirect measure of systemic arterial stiffness. It increases with age (7).

Left ventricular mass

It is a strong predictor of adverse cardiovascular events. This parameter increases with age (8, 9).

Brachial pulse pressure

It is the difference between systolic and diastolic blood pressure. It increases with age and is an established marker of cardiovascular diseases (10).

Pulse-wave velocity

A clinically useful indicator of arterial stiffness. It is the speed at which pressure waves generated from systolic contractions move through the arteries (11).

 

Assessing the aging impact on pulmonary function

Lung function is a reliable physiological marker of aging. The literature indicates that aerobic capacity decreases by more than 20% per decade after 70 years (3). In the same context, research shows that the aging process alters the structure and function of the lung and supportive parts, like the chest wall and respiratory muscles (12). These changes trigger unfavorable lung mechanisms associated with increased air trapping, reduced gas exchange, and decreased expiratory airflow.

Lung function testing represents a helpful tool that determines the aging impact on the respiratory tract. The table below captures physiological pulmonary tests that could help assess lung health and how aging has impacted it (3, 13-22).

Functional parameter

Definition

Peak aerobic capacity (VO2Peak)

Is the person’s capacity to maximize oxygen use while performing physical activity. It declines as individuals age. It decreases by 3-6% in the third and fourth decades of life.

Spirometry (FEV1, FVC, FEV1/FVC ratio)

A common pulmonary test that assesses fitness and monitors lung function. According to research, lung function declines with age.

Lung volumes (TLC, FRC, RV)

Lung volumes help monitor lung health over time. Changes in these volumes start to appear after the age of 35. For example, FRC increases with age due to reduced lung elasticity, making air harder to expel. RV and TLC also increase due to aging.

Diffusing capacity for carbon monoxide

It measures the lung's capacity to transfer carbon monoxide from inspired air into the bloodstream. It decreases with aging, but maintaining a healthy lifestyle and exercising could ease the decline.

Quantitative ventilation-perfusion scanning

It is an established parameter for lung function. The mismatch between ventilation/perfusion increases with age due to airway closure in certain parts of the lung.

FEV1: Forced expiratory volume in the first second; FVC: Forced vital capacity; TLC: Total lung capacity; FRC: Functional residual capacity; RV: Residual volume.

Image 2

Physiological measurements to assess the age-related impact on renal function

Under normal conditions, the kidneys are highly metabolic organs that are impacted by aging. According to the literature, the kidneys undergo structural and functional changes due to aging (23). For example, research highlights that kidney mass changes by up to 25% between the third and eighth decades of life. Nephrosclerosis (hardening of the wall lining small arteries and arterioles supplying the kidney), a hallmark of kidney aging, will cause the loss of up to 6500 nephrons (the structural and functional unit of the kidney. Each kidney has an average of 900,000 to 1 million nephrons) per year after the age of 30 (3, 23, 24). Also, the glomerular filtration rate (GFR) (a biomarker showing kidneys' filtration capacity or how well they work) falls by about 5–10 % per decade after the age of 35 years (23).

Several tests could be utilized to assess the impact of aging on renal function. They are listed below (3, 25).

Functional parameter

Definition

Creatinine clearance

It is the volume of plasma cleared of creatinine per time unit. Research shows that it declines with age.

Glomerular filtration Rate (GFR)

A test that is used to detect how well the kidneys function. Glomeruli are kidney structures that remove waste. GFR decreases with age.

 

Musculoskeletal system and physiological markers

Like other bodily systems, multiple players in the musculoskeletal system are affected by aging. For example, skeletal muscle mass and strength decline with aging (26). Also, tendons, bones, and cartilages are impacted by age.

There are several parameters that could be assessed to determine the overall impact of age on the musculoskeletal system. They are summarized in the following table (3, 27-31).

Functional parameter

Definition

Grip strength

A measure that is widely adopted as a useful indicator of overall strength. In addition to measuring grip strength, it assesses upper limb function, bone mineral density, presence of comorbidities, and others.

Unipedal stance test of balance

It is a test that is used to assess postural balance.

Grooved pegboard test of fine motor coordination

It is a test that measures fine-motor task speed on both sides of the body.

SF-36 physical functioning scale

A questionnaire that evaluates the overall quality of life by incorporating several measures, including physical functioning.

Gait speed

The walking test could serve as a subjective estimator of general health and skeletal muscle mass.

SF: Short form.

Image 3

Other physiological measurements

In addition to the measurements listed above, other systems and bodily functions are impacted by aging. Examples include the immune system, neurocognitive function, integumentary (skin and appendages) system, and sensory system (3).

The table below compiles a number of physiological measures that could help understand the impact of aging on different body parts by assessing these parameters (3, 32-41).

Functional parameter

Definition

Immune risk profile (immune system)

It assesses a cluster of parameters, including proteins CD4, CD8, CD19, and others. Elevations of this profile are associated with functional limitations and mortality in the elderly.

Mini-mental status examination (neurocognitive)

A test that is used to detect cognitive impairment. Research shows that test scores decrease with age.

Cognitive battery (neurocognitive)

It is a test that assesses key cognitive abilities, like attention, memory, and verbal fluency.

Visual acuity (sensory)

A test based on a chart containing 11 lines, with each line including letters of various sizes.

Auditory tests (sensory)

These are tests that assess age-related hearing loss.

Skin elasticity tests (integumentary system)

Tests to assess skin elasticity. They help identify age-related changes occurring to the skin. The literature indicates that skin elasticity decreases with aging.

Skin thickness (integumentary system)

Tests carried out to determine skin thickness, as research shows that it decreases with age.

Wrinkle parameters measurement (integumentary system)

Wrinkles increase due to multiple factors associated with aging, like collagen loss. Measuring wrinkles could help determine the impact of aging on the skin.

Conclusions

The aging process carries many changes to different body organs and systems. Research has established that the aging process causes a decline in the overall body function. There are physiological parameters that could help establish how far aging has impacted the body to capture these changes. Although these parameters may not be specifically established to understand the said impact, they provide a clear picture of how aging leads to changes in physiological parameters. Capturing and understanding the value of these physiological measurements could help establish how different biological age is from chronological age.

 

References

1.            North BJ, Sinclair DA. The intersection between aging and cardiovascular disease. Circulation research. 2012;110(8):1097-108.

2.            Strait JB, Lakatta EG. Aging-associated cardiovascular changes and their relationship to heart failure. Heart failure clinics. 2012;8(1):143-64.

3.            Khan SS, Singer BD, Vaughan DE. Molecular and physiological manifestations and measurement of aging in humans. Aging Cell. 2017;16(4):624-33.

4.            Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Frontiers in public health. 2017;5:258-.

5.            Jandackova VK, Scholes S, Britton A, Steptoe A. Are Changes in Heart Rate Variability in Middle-Aged and Older People Normative or Caused by Pathological Conditions? Findings From a Large Population-Based Longitudinal Cohort Study. Journal of the American Heart Association. 2016;5(2):e002365.

6.            Lerman DA, Prasad S, Alotti N. Calcific Aortic Valve Disease: Molecular Mechanisms and Therapeutic Approaches. European cardiology. 2015;10(2):108-12.

7.            Wilkinson IB, MacCallum H, Flint L, Cockcroft JR, Newby DE, Webb DJ. The influence of heart rate on augmentation index and central arterial pressure in humans. The Journal of physiology. 2000;525 Pt 1(Pt 1):263-70.

8.            Nethononda RM, McGurk KA, Whitworth P, Francis J, Mamasoula C, Cordell HJ, et al. Marked variation in heritability estimates of left ventricular mass depending on modality of measurement. Scientific Reports. 2019;9(1):13556.

9.            Stokar J, Leibowitz D, Durst R, Shaham D, Zwas DR. Echocardiography overestimates LV mass in the elderly as compared to cardiac CT. Plos one. 2019;14(10):e0224104.

10.          Verdecchia P, Angeli F. Does brachial pulse pressure predict coronary events? Atherosclerosis, Large Arteries and Cardiovascular Risk. 2007;44:150-9.

11.          Kang J, Han K, Hyung J, Hong G-R, Yoo Y. Noninvasive Aortic Ultrafast Pulse Wave Velocity Associated With Framingham Risk Model: in vivo Feasibility Study. Frontiers in Cardiovascular Medicine. 2022;9.

12.          Skloot GS. The Effects of Aging on Lung Structure and Function. Clin Geriatr Med. 2017;33(4):447-57.

13.          Gater DR. CHAPTER EIGHTEEN - Exercise and Fitness with Spinal Cord Injury. In: Sisto SA, Druin E, Sliwinski MM, editors. Spinal Cord Injuries. Saint Louis: Mosby; 2009. p. 430-54.

14.          Jakovljevic DG. Physical activity and cardiovascular aging: Physiological and molecular insights. Experimental Gerontology. 2018;109:67-74.

15.          Lamb K, Theodore D, Bhutta BS. Spirometry. 2020.

16.          Thomas ET, Guppy M, Straus SE, Bell KJL, Glasziou P. Rate of normal lung function decline in ageing adults: a systematic review of prospective cohort studies. BMJ Open. 2019;9(6):e028150.

17.          Lutfi MF. The physiological basis and clinical significance of lung volume measurements. Multidisciplinary Respiratory Medicine. 2017;12(1):3.

18.          Modi P, Cascella M. Diffusing capacity of the lungs for carbon monoxide. 2020.

19.          Coffman KE, Carlson AR, Miller AD, Johnson BD, Taylor BJ. The effect of aging and cardiorespiratory fitness on the lung diffusing capacity response to exercise in healthy humans. Journal of Applied Physiology. 2017;122(6):1425-34.

20.          Cardús J, Burgos F, Diaz O, Roca J, Barberà JA, Marrades RM, et al. Increase in pulmonary ventilation-perfusion inequality with age in healthy individuals. Am J Respir Crit Care Med. 1997;156(2 Pt 1):648-53.

21.          Green FHY, Pinkerton KE. Chapter 27 - Environmental Determinants of Lung Aging. In: Harding R, Pinkerton KE, editors. The Lung (Second Edition). Boston: Academic Press; 2014. p. 471-91.

22.          Powers KA, Dhamoon AS. Physiology, Pulmonary Ventilation and Perfusion. 2019.

23.          Fang Y, Gong AY, Haller ST, Dworkin LD, Liu Z, Gong R. The ageing kidney: Molecular mechanisms and clinical implications. Ageing research reviews. 2020;63:101151-.

24.          Bertram JF, Douglas-Denton RN, Diouf B, Hughson MD, Hoy WE. Human nephron number: implications for health and disease. Pediatr Nephrol. 2011;26(9):1529-33.

25.          Glassock RJ, Winearls C. Ageing and the glomerular filtration rate: truths and consequences. Transactions of the American Clinical and Climatological Association. 2009;120:419-28.

26.          Frontera WR. Physiologic Changes of the Musculoskeletal System with Aging: A Brief Review. Phys Med Rehabil Clin N Am. 2017;28(4):705-11.

27.          Bohannon RW. Grip Strength: An Indispensable Biomarker For Older Adults. Clinical interventions in aging. 2019;14:1681-91.

28.          Springer BA, Marin R, Cyhan T, Roberts H, Gill NW. Normative values for the unipedal stance test with eyes open and closed. Journal of geriatric physical therapy. 2007;30(1):8-15.

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Dr. Ana Baroni MD. Ph.D.
SCIENTIFIC & MEDICAL ADVISOR
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Dr. Ana Baroni MD. Ph.D.

Scientific & Medical Advisor
Quality Garant

Ana has over 20 years of consultancy experience in longevity, regenerative and precision medicine. She has a multifaceted understanding of genomics, molecular biology, clinical biochemistry, nutrition, aging markers, hormones and physical training. This background allows her to bridge the gap between longevity basic sciences and evidence-based real interventions, putting them into the clinic, to enhance the healthy aging of people. She is co-founder of Origen.life, and Longevityzone. Board member at Breath of Health, BioOx and American Board of Clinical Nutrition. She is Director of International Medical Education of the American College of Integrative Medicine, Professor in IL3 Master of Longevity at Barcelona University and Professor of Nutrigenomics in Nutrition Grade in UNIR University.

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