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Managing the Age-Related Loss of Pulmonary Function: Extending Life by Expanding Lungs

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

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Managing the Age-Related Loss of Pulmonary Function: Extending Life by Expanding Lungs

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  1. Managing the Age-Related Loss of Pulmonary Function: Extending Life by Expanding Lungs Al Sears, MD

  2. 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

  3. 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.

  4. 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.

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

  6. 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.

  7. Some Good News... The age-related loss of pulmonary function is manageable and modifiable

  8. Factors Influencing Lung Capacity Non-Modifiable Modifiable Weight Smoking status Exercise • Age • Gender • Height

  9. Exercise for Lung Expansion Cardiopulmonary exercise falls into 2 broad categories: • 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 • High-intensity, short duration: short bursts of exercise, aiming for >80% of maximum heart rate. Interval training falls in this category

  10. 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

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

  12. High-Intensity Exercise Reduces Risk of Cardiovascular Disease Relative Risk for CHD Energy Expenditure (kJ/week)

  13. 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

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

  15. The Bottom Line High-intensity, short-duration exercise is the best type of exercise for increasing lung capacity and decreasing risk of death

  16. The Challenge How do we bring the benefits of high-intensity training to the average deconditioned patient at an age-management clinic?

  17. The Solution P.A.C.E. Progressively Accelerating Cardiopulmonary Exertion

  18. Progressivity • Progressivity • Repeated changes in the same direction. • Regular and consistent increases in the intensity of demands placed on cardiovascular system

  19. Acceleration • Acceleration • Training for faster and faster responses • Target heart rate will be reached more quickly • Recovery to resting heart rate also happens more quickly

  20. PACE – The Twin Study

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

  22. Terri L – Body Fat (%) Body Fat (%) Months Post-Training

  23. Terri L – Triglycerides Triglycerides (mg/dL)

  24. Terri L – HDL HDL (mg/dL)

  25. Terri L – Before

  26. Terri L – After

  27. Sample PACE Log

  28. What Makes a PACE Work Out? • Running • Rowing • Swimming • Bicycling • Jumping rope • Calisthenics • Stair stepping • Elliptical • Circuit training • Hindu squats • Kettle bells

  29. PACE Trial My Wellness Research Foundation is currently conducting a longitudinal study to examine the efficacy of the PACE program

  30. 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 • VO2max and pulmonary function

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