Right Heart Cardiac Magnetic Resonance Profiles and Cardiopulmonary Reserve in Older Adults Undergoing Long-Term Multicomponent Exercise: A 2-Year Longitudinal Study.

Right heart geometry and function are essential for preserving physical performance in healthy aging, yet evidence regarding how long-term supervised multicomponent exercise influences right heart characteristics and cardiopulmonary reserve over time remains limited. To address this gap, this interim analysis of a prospective, non-randomized, two-armed cohort study included 155 adults aged ≥ 65 years assigned to supervised multicomponent training (n = 75) or education control group (n = 80). Cardiac magnetic resonance imaging and cardiopulmonary exercise testing were performed at baseline, 1-year, and 2-year follow-ups, with right heart structure and function as the primary outcomes; post hoc analyses were stratified by training adherence. Among these participants, 92 (training: n = 54; control: n = 38) completed the 2-year follow-up and were included in the final analysis. No significant time × group interactions were detected for right or left heart parameters (all p > 0.05). After multivariable adjustment, the exercise group showed higher overall adjusted mean values for right atrial volumes and selected right ventricular functional measures, including stroke volume, cardiac index, and peak filling rate (all p < 0.05). In contrast, significant time × group interactions were identified for peak VO2 (p = 0.003), and VO2 at AT (p = 0.033), indicating distinct longitudinal cardiopulmonary trajectories between groups. Post hoc subgroup analyses showed that between-group differences in right heart volumetric measures persisted through 2 years in the high-adherence group, whereas those in the low-adherence group were less consistent. Overall, 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. These findings suggest that exercise-related benefits in healthy aging may be characterized primarily by functional adaptations rather than longitudinal structural cardiac remodeling. Trial Registration: The original study was registered at https://www.chictr.org.cn/bin/userProject (ChiCTR2000032404, Registered on April 27, 2020).