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Are Your Lungs Dying? Reversing the Age-Related Loss of Heart and Lung Capacity

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

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Are Your Lungs Dying? Reversing the Age-Related Loss of Heart and Lung Capacity

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  1. Are Your Lungs Dying?Reversing the Age-Related Loss of Heart and Lung Capacity Al Sears, MD

  2. 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”

  3. What if Everything You Thought You Knew About Exercise Was Wrong?

  4. The “Big 3” Cause More Problems Than They Solve Aerobics Cardio Weight training These modern approaches to exercise don’t work.

  5. 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

  6. 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.

  7. 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

  8. Exercise Intensity and MortalityHarvard 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

  9. 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

  10. Are Your Lungs Dying? Mean Vital Capacity (dL) 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.

  11. FEV1 Declines With Age FEV1 (liters) Age Adapted from: Dean, W. Biological Aging Measurement. 1988

  12. VO2Max Declines With Age VO2max (ml/kg/min) Age Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005

  13. Even Moderate Pulmonary Impairment Increases Risk of Death Relative Risk of Death (all causes) FEV (%)Quintile: Years Post Follow-Up 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.

  14. 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

  15. 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.

  16. The Bottom Line Kannel WB, Seidman JM, Fercho W, Castelli WP. Vital Capacity and Congestive Heart Failure. The Framingham Study. Circulation. 1974;49(6):1160-1166. 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.

  17. Some Good News... It’s possible to reverse the age-related loss of pulmonary function … if you focus on exercise intensity

  18. Pre- and Post-Intervention Pulmonary Function VO2peak (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.

  19. Building Younger Lungs Max O2 Uptake (ml/Kg min) Age Adapted from: von Ardennne, M. Oxygen Multistep Therapy. Theime. 1990. p.31.

  20. But what is happening to our heart capacity?

  21. Maximum HR Declines With Age Max HR (BPM) Age Adapted from: Dean, W. Biological Aging Measurement. 1988

  22. 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.

  23. Some More Good News... It’s possible to reverse the age-related loss of cardiac function … if you focus on exercise intensity

  24. High-Intensity Exercise Improves Cardiac Function – Study Design *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.

  25. High-Intensity Exercise Improves Peak O2 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.

  26. High-Intensity Exercise Improves Ejection Fraction During Exercise * P = 0.024 Change in ejection fraction (%) 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.

  27. Low-Intensity Exercise Reduces Cardiac Function ∆ Rest to Peak LVEF (%) 6-months 12-months 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.

  28. 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

  29. 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

  30. 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.

  31. 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.

  32. 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

  33. 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

  34. 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

  35. Exercise Intensity and Metabolism Adapted from: McArdle W et al. Sports & Exercise Nutrition. New York, NY: Lippincott, Williams & Wilkins;1999

  36. 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

  37. The Solution P.A.C.E PROGRESSIVELY ACCELERATING CARDIOPULMONARY EXERTION

  38. 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

  39. 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

  40. PACE – The Twin Study

  41. PACE Twin Study – Body Fat Loss Pounds of Fat Lost Weeks Post-Training

  42. PACE Twin Study – Change in Lean Body Mass Change in Lean Body Mass (lbs) Weeks Post-Training

  43. PACE Case Study –T.L. • 55 year-old female • 250-lbs • 50% body fat • Elevated triglycerides • Low HDL

  44. T.L. – Body Fat (%) Body Fat (%) Months Post-Training

  45. T.L. – Triglycerides Triglycerides (mg/dL)

  46. T.L. – HDL HDL (mg/dL)

  47. PACE Case Study – M.P. • 283-lb male • 42% body fat • Taking 11 prescription drugs to manage obesity-related conditions

  48. M.P. – Body Fat (%) Body Fat (%) Months post-training

  49. M.P. – Increase in Lean Body Mass Change in Lean Body Mass (lbs) Months post-training

  50. Sample PACE Log

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