Presentation on theme: "Managing the Age-Related Loss of Pulmonary Function: Extending Life by Expanding Lungs Al Sears, MD."— Presentation transcript:
Managing the Age-Related Loss of Pulmonary Function: Extending Life by Expanding Lungs Al Sears, MD
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
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.
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.
Even Moderate Pulmonary Impairment Increases Risk of Death Years Post Follow-Up FEV (%) Quintile: Relative Risk of Death (all causes)
The Data are Clear Lung capacity decreases with age Decreased lung capacity 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.
Some Good News... The age-related loss of pulmonary function is manageable and modifiable
Factors Influencing Lung Capacity Non-Modifiable Age Gender Height Modifiable Weight Smoking status Exercise
Exercise for Lung Expansion Cardiopulmonary exercise falls into 2 broad categories: 1.Low/moderate intensity, long-duration: traditional “cardio” exercises (i.e., aerobics classes, distance jogging). Participants told to keep HR between 70 – 80% of maximum for 30 – 60 minutes 2.High-intensity, short duration: short bursts of exercise, aiming for >80% of maximum heart rate. Interval training falls in this category
Does Intensity Matter? With regard to reducing the overall risk of death, the current research unequivocally supports the superiority of high-intensity exercise over low/moderate-intensity exercise
Pre- and Post-Intervention Pulmonary Function VO 2peak (L/min) Exercise Group 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.
High-Intensity Exercise Reduces Risk of Cardiovascular Disease Relative Risk for CHD Energy Expenditure (kJ/week)
Exercise Intensity and Mortality Harvard Health Study 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 Relative Risk of Death (%)
Building Younger Lungs Max O 2 Uptake (ml/Kg min) Age Adapted from: von Ardennne, M. Oxygen Multistep Therapy. Theime. 1990. p.31.
The Bottom Line High-intensity, short-duration exercise is the best type of exercise for increasing lung capacity and decreasing risk of death
The Challenge How do we bring the benefits of high-intensity training to the average deconditioned patient at an age-management clinic?
The Solution P.A.C.E. Progressively Accelerating Cardiopulmonary Exertion
Progressivity Repeated changes in the same direction. Regular and consistent increases in the intensity of demands placed on cardiovascular system
Acceleration Training for faster and faster responses Target heart rate will be reached more quickly Recovery to resting heart rate also happens more quickly
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
Case Study – Terri L. 55 year-old female 250-lbs 50% body fat Elevated triglycerides Low HDL
Terri L – Body Fat (%) Body Fat (%) Months Post-Training
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 Work Out? Running Rowing Swimming Bicycling Jumping rope Calisthenics Stair stepping Elliptical Circuit training Hindu squats Kettle bells
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 VO 2max and pulmonary function