Arterial and cardiac adaptations with healthy aging and the relationship with arterial-ventricular coupling. With healthy aging the arterial and cardiac systems undergo considerable remodeling (change in collagen, reduced elastin, accumulation of advanced glycation end products, loss in cardiomyocytes, and altered autonomic tone), which uncouple the heart and arterial system at rest and during exercise. This uncoupled arterial and cardiac interaction (AV uncoupling) is further exacerbated (double arrows) in the presence of cardiovascular (CV) diseases (such as hypertension and metabolic syndrome) especially during exercise. However, evidence suggests that exercise training can re-couple the interaction between the heart and arterial systems. SNS, sympathetic nervous system; BP, blood pressure; Ca+, calcium; LV, left ventricle; Beta-adrenergic receptors.