How was it discovered that there is no such thing as an overall, general, cardiopulmonary fitness? Out of shape college kids were recruited for a study where they trained on a stationary bike for 90 days, but only one leg did the pedaling. Before they started training, their VO2max was tested, first using both legs, then only the left leg, and then just the right leg. (VO2max is a measurement of cardiopulmonary efficiency.) As you might imagine, all three results were the same. Then one leg was worked out for 90 days on the bicycle; the other leg got to continue to be a couch potato. At the end of the 90 days, you could tell by looking which leg had been exercised. Now for the revealing part. When VO2max was tested for the leg that had been trained, its VO2max improved as expected. But what do you think happened when the unexercised leg was tested? Do you think its VO2max also improved along with the other leg, or do your think there was no improvement. It's shocking how many personal trainers and exercise physiologists that I put this question to got it wrong. There was no improvement. Proving that cardiopulmonary efficiency is muscle specific. This means that when you get less winded, and your heart rate no longer rises as much after you've trained to do something, it's not your heart or lungs that accounted for the improvement, it's the muscles involved.
It is well known that exercise in the older population may prevent several diseases [1–4]. Reduced physical activity impairs the quality of life in elderly people with Alzheimer's Disease , Parkinson's Disease , and Depressive Disorders . Moreover, musculoskeletal, cardiopulmonary, and cerebrovascular decline are associated with poor physical fitness because of the cumulative effects of illness, multiple drug intake, fatigue, and bed rest [7, 8]. The effects of physical activity and exercise programs on fitness and health-related quality of life (HRQOL) in elderly adults have been widely studied by several authors [9–11]. De Vries et al.  conducted a meta-analysis focusing on elderly patients with mobility problems and/or multimorbidity. Eighteen articles describing a wide variety of actions were analyzed. Most used a multicomponent training program focusing on the combination of strength, balance, and endurance training. In 9 of the 18 studies included, interventions were supervised by a physical therapist. Intensity of the intervention was not reported and the duration of the intervention varied from 5 weeks to 18 months. This meta-analysis concluded that, considering quality of life, the exercise versus no-exercise studies found no significant effects. High-intensity exercise appears to be somewhat more effective in improving physical functioning than low-intensity exercise. These positive effects are of great value in the patient population but the most effective type of intervention remains unclear. Brovold et al.  recently examined the effects of high-intensity training versus home-based exercise programs using the Norwegian Ullevaal Model  on a group of over-65-year-olds after discharge from hospital. These authors based their study on the Swedish Friskis-Svettis model  which was designed by Johan Holmsater for patients with coronaropathy to promote their return to work and everyday activities and improve their prognoses. This model includes three intervals of high intensity and two intervals of moderate intensity, each one lasting for 5 to 10 minutes. Included in each is coordination. Exercises consist of simple aerobic dance movements and involve the use of both upper and lower extremities to challenge postural control . Exercise intensity was adjusted using the Borg Rating of Perceived Exertion (RPE) Scale. Moderate intensity was set between 11 and 13, and high intensity was set between 15 and 17 on the Borg Scale.