Presentation on theme: "Are Your Lungs Dying? Reversing the Age-Related Loss of Heart and Lung Capacity Al Sears, MD."— Presentation transcript:
Are Your Lungs Dying? Reversing the Age-Related Loss of Heart and Lung Capacity Al Sears, MD
Let’s look at what the “experts” are recommending: American Medical Association Moderate intensity exercise for 30-minutes/day, at least 5 days/week American College of Sports Medicine Moderate intensity exercise for 30-minutes/day, at least 5 days/week American Heart Association Moderate intensity exercise for 30-minutes/day, at least 5 days/week National Institute of Health “regular, moderate exercise”
What if Everything You Thought You Knew About Exercise Was Wrong?
The “Big 3” Cause More Problems Than They Solve 1.Aerobics 2.Cardio 3.Weight training These modern approaches to exercise don’t work.
The Advice from the “Experts” Take You Down the Wrong Path Modern Exercise Advice won’t help you: 1) Build functional strength 2) Make your heart stronger 3) Improve lung capacity
INTENSITY VS. DURATION 8,896 recreational runners reported average exercise duration and intensity High-intensity exercise associated with: Lower blood pressure Lower triglycerides Lower CHOL/HDL ratios Lower BMIs Lower waist, hip, and chest circumferences Exercise duration had no effect on these parameters Williams P. Relationships of heart disease risk factors to exercise quantity and intensity. Arch Intern Med. 1998;158(3):237-245.
HARVARD ALUMNI HEALTH STUDIES 17,321 male alumni followed for 20 years High-intensity exercise was associated with a significant decrease in all-cause mortality No relationship between low-intensity exercise and death Lee IM, Hsieh, CC, Paffenparger, RS Jr. Exercise intensity and longevity in men. The Harvard Alumni Health Study. JAMA. 1995;273(15):1179-1184.
Exercise Intensity and Mortality Harvard Health Study Relative Risk of Death (%) Exercise Intensity Lee IM, Hsieh, CC, Paffenparger, RS Jr. Exercise intensity and longevity in men. The Harvard Alumni Health Study. JAMA. 1995;273(15):1179-1184
The Data are Clear... Prestigious studies like the Framingham Heart Study and the Harvard Health Study have demonstrated that exercise intensity – not duration – is predictive of health and longevity
Are Your Lungs Dying? Age Mean Vital Capacity (dL) Adapted from: Kannel WB, Seidman JM, Fercho W, Castelli WP. Vital Capacity and Congestive Heart Failure. The Framingham Study. Circulation. 1974;49(6):1160-1166.
FEV 1 Declines With Age Age FEV 1 (liters) Adapted from: Dean, W. Biological Aging Measurement. 1988
VO 2Max Declines With Age VO 2max (ml/kg/min) Age Wilmore J & Costill D. Physiology of Sport and Exercise:3 rd Edition. Campaign, IL: Human Kinetics. 2005
Even Moderate Pulmonary Impairment Increases Risk of Death Years Post Follow-Up FEV (%) Quintile: Relative Risk of Death (all causes) Schunemann H, et al. Pulmonary function is a long-term predictor of mortality in the general population: 29-year follow-up of the Buffalo Health Study. Chest. 2000 Sep;118(3):656-64.
Framingham Heart Study Framingham researchers followed 5209 participants over 18 years Biggest finding: the risk of congestive heart failure rose as lung capacity fell Relationship was independent of: blood pressure, relative weight, pulse, smoking status, heart enlargement, ECG-LVH, blood glucose levels, and age Lung volume decreased BEFORE there was any clinical evidence of CHF
Incidence of Congestive Heart Failure According to Vital Capacity Rate of CHF/1000 Vital Capacity (L/height) Age Adapted from: Kannel WB, Seidman JM, Fercho W, Castelli WP. Vital Capacity and Congestive Heart Failure. The Framingham Study. Circulation. 1974;49(6):1160-1166.
The Bottom Line Lung capacity decreases with age Decreased lung capacity increased risk of all- cause mortality and increased risk of heart failure Even moderate, non-clinical decreases in lung capacity increase risk of death Lung capacity is a clear and powerful marker of aging. Kannel WB, Seidman JM, Fercho W, Castelli WP. Vital Capacity and Congestive Heart Failure. The Framingham Study. Circulation. 1974;49(6):1160-1166.
Some Good News... It’s possible to reverse the age-related loss of pulmonary function … if you focus on exercise intensity
Pre- and Post-Intervention Pulmonary Function VO 2peak (L/min) Adapted from: Baily S, Wilkerson DiMenna F, Jones A. Influence of repeated sprint training on pulmonary O2 uptake and muscle deoxygenation kinetics in humans. J Appl Physiol. 2009 Jun;106(6):1875-87.
Building Younger Lungs Max O 2 Uptake (ml/Kg min) Age Adapted from: von Ardennne, M. Oxygen Multistep Therapy. Theime. 1990. p.31.
But what is happening to our heart capacity?
Maximum HR Declines With Age Adapted from: Dean, W. Biological Aging Measurement. 1988 Max HR (BPM) Age
Cardiac Output Declines With Age Cardiac Output (L/min) Age Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
Some More Good News... It’s possible to reverse the age-related loss of cardiac function … if you focus on exercise intensity
High-Intensity Exercise Improves Cardiac Function – Study Design Patients with prior MI (n = 29) Control/no training (n = 8) Low-intensity training* (n = 11) High-intensity training** (n = 10) *Low-intensity: HR @ 80% of gas exchange threshold (GET) **High-intensity: (HR @ GET – HR @ peak exercise)(40%) + HR @ GET Adachi H, Koike A, Obayashi T, et al. Does appropriate endurance exercise training improve cardiac function in patients with prior myocardial infarction? Eur Heart J. 1996 Oct;17(10):1511-21.
High-Intensity Exercise Improves Peak O 2 Uptake During Exercise Adachi H, Koike A, Obayashi T, et al. Does appropriate endurance exercise training improve cardiac function in patients with prior myocardial infarction? Eur Heart J. 1996 Oct;17(10):1511-21.
High-Intensity Exercise Improves Ejection Fraction During Exercise Change in ejection fraction (%) * P = 0.024 Adachi H, Koike A, Obayashi T, et al. Does appropriate endurance exercise training improve cardiac function in patients with prior myocardial infarction? Eur Heart J. 1996 Oct;17(10):1511-21.
Low-Intensity Exercise Reduces Cardiac Function 6-months12-months ∆ Rest to Peak LVEF (%) Oberman, A, Fletcher F, Lee J, et al. Efficacy of high-intensity exercise training on left ventricular ejection fraction in men with coronary artery disease (the Training Level Comparison Study). Am J Cardiol. 1995 Oct 1;76(10):643-7.
The Faustian Bargain of Fitness To keep up with popular trends, you will increase cardiac endurance but lose the one thing that will save you from a heart attack: Cardiac Capacity
Do Humans Really Need Endurance Training? Ancient man never had the need for long-duration, medium-intensity exertion. This is also true in the animal kingdom. Short bursts of high-intensity are the norm for both man and animals. This kind of exertion is natural for survival, i.e. – escaping from predators, hunting, climbing
Your Heart Doesn’t Need Endurance Training The heart was designed by nature to last a lifetime. It doesn’t need training to pump blood for 80 or even 90 years. If you train for endurance, you only increase efficiency in the narrow range of medium-intensity output.
Endurance Training is a High- Risk Challenge This kind of activity forces your body to make dangerous choices, via adaptive responses: Regulation of body temperature Metabolism of waste products Conservation of energy – forces the storage of energy to maintain supply for repeated duration challenges. This usually occurs as the production and storage of body fat.
Sacrificing Your Ability to Survive a Deadly Heart Attack The energy you need to fuel endurance training wipes out your heart’s reserve capacity In a weakened state, your heart has no reserve energy to supply a sudden demand for more oxygen During times of stress, this inability to rapidly supply more oxygen results in a heart attack
Cardiac Reserve and Heart Failure Maximal level Cardiac Power Output* (w) * Cardiac Power Output = (cardiac output)(arterial pressure) Adapted from: Williams S, Barker D, Goldspink D, Tan L. A reappraisal of concepts in heart failure: central role of cardiac power reserve. Arch Med Sci 2005; 1(2) 65-74
These Data Support the Need to Reclaim Native Fitness High-intensity exertion – the kind practiced by our ancient ancestors – is the key to modern cardiopulmonary health
Exercise Intensity and Metabolism What Does Your Body Use for Fuel? ACTIVITY LEVELPROTEINCARBSFAT Resting 1 to 5%35%60% Low intensity 5 – 8%70%15% Moderate Intensity 2 to 5%40%55% High Intensity 2%95%3% Adapted from: McArdle W et al. Sports & Exercise Nutrition. New York, NY: Lippincott, Williams & Wilkins;1999
The German Secret to Olympic Gold Interval training was the first formalized style of high- intensity exertion used to train athletes in the 1930’s However...interval training is demanding and not suited for people who are deconditioned and/or grossly overweight
The Solution P.A.C.E PROGRESSIVELY ACCELERATING CARDIOPULMONARY EXERTION
The One Think Modern Exercise Lacks: Progressivity Regular and consistent increases in the intensity of demands placed on the cardiovascular system by making repeated changes in the same direction Analogous to inflating a balloon: the best way to fill a balloon to capacity is by gradually adding more air during each inflation Similar to muscle hypertrophy training where muscle capacity is increased by progressively adding small amounts of additional weight KEY POINT: In PACE, high-intensity is a relative term. This means that each individual will work towards their own unique level of maximum exertion. This makes PACE the safest form of exercise
Improving Your Response Time: Acceleration Training to increase the speed at which the heart and lungs respond to increases in demand Recovery back to resting heart rate/respiration also happens more quickly KEY POINT: most cardiac arrests occur when the heart is unable to respond to a sudden and dramatic increase in demand. Training for acceleration helps the heart to respond quickly to potentially life- threatening demands – reducing the risk of sudden cardiac death
PACE – The Twin Study Female Fraternal Twins 18-years old 24.5% body fat 16-weeks of training PACE Twin Decreased body fat by14.5% Gained 9-lbs lean muscle “Cardio” Twin Decreased body fat by 5% Lost 2-lbs lean muscle
PACE Twin Study – Body Fat Loss Pounds of Fat Lost Weeks Post-Training
PACE Twin Study – Change in Lean Body Mass Weeks Post-Training Change in Lean Body Mass (lbs)
PACE Case Study –T.L. 55 year-old female 250-lbs 50% body fat Elevated triglycerides Low HDL
T.L. – Body Fat (%) Body Fat (%) Months Post-Training
T.L. – Triglycerides Triglycerides (mg/dL)
T.L. – HDL HDL (mg/dL)
PACE Case Study – M.P. 283-lb male 42% body fat Taking 11 prescription drugs to manage obesity-related conditions
M.P. – Body Fat (%) Months post-training Body Fat (%)
M.P. – Increase in Lean Body Mass Months post-training Change in Lean Body Mass (lbs)
Sample PACE Log Warm up:_______________ Exercise:_________________ Initial Sets Set 1Set 2Set 3 ExertionRecoveryExertionRecoveryExertionRecovery Additional (optional) Sets Set 4Set 5Set 6 ExertionRecoveryExertionRecoveryExertionRecovery
What Makes a PACE Workout? Running Rowing Swimming Bicycling Jumping rope Calisthenics Stair stepping Elliptical Circuit training Hindu squats Kettle bells
PACE is Safe, Effective and Non- Threatening Interval training requires high-performance and aggressive goals, which may not be realistic for the average person. In contrast, PACE is progressively challenging. This allows the individual to set goals based on their current level of conditioning. Over time, high-intensity exertion becomes possible PACE is not psychologically or emotionally threatening. Because you start at a level that is comfortable, even if all you can do is walk, the idea of exertion and exercise is non-threatening
PACE Trial My Wellness Research Foundation is currently conducting a longitudinal study to examine the efficacy of the PACE program
PACE Trial – Study Design 20 men and women (18+) with > 26% body fat PACE-style exercise program supervised by an ACE- certified trainer Variables assessed include: Weight Body fat & lean muscle mass Cholesterol Glucose and insulin Testosterone CRP and homocysteine VO2 max and pulmonary function