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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 - PowerPoint PPT Presentation
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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?
32 37 42 47 52 57 62 67 72 7715
20
25
30
35
40
45
Men
Women
Age
Mea
n V
ital C
apac
ity (
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
45 - 54 55 - 64 65 - 740
1
2
3
4
5
6
7
8
9
10
<4.54.5 - 5.15.2 - 5.7>5.7
Rat
e o
f C
HF
/100
0
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
5 yr 10 yr0.5
1
1.5
2
2.5
5th4th3rd2nd1st
Years Post Follow-Up
FEV (%)Quintile:
Rel
ati
ve
Ris
k o
f D
eath
(al
l ca
use
s)
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
RST ET Control2.85
2.9
2.95
3
3.05
3.1
3.15
3.2
3.25
3.3
Pre-intervention
Post-intervention
VO
2pea
k (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
None 1 - 2,099 2,100 - 4,199 4,200 - 8,399 >8,4000
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1P, trend = 0.042
Rel
ativ
e R
isk
for
CH
D
Energy Expenditure (kJ/week)
Exercise Intensity and MortalityHarvard Health Study
Low Moderate High0.840000000000001
0.860000000000001
0.880000000000001
0.900000000000001
0.920000000000001
0.940000000000001
0.960000000000001
0.980000000000001
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
Rel
ativ
e R
isk
of D
eath
(%
)
Building Younger Lungs
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 1000
10
20
30
40
50
60
People participating in high-intensity interval exercise
Average people
Max
O2 U
pta
ke (
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
• Progressivity
• Repeated changes in the same direction.
• Regular and consistent increases in the intensity of demands placed on cardiovascular system
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
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 (%)B
ody
Fat
(%
)
Months Post-Training
1 2 3 4 5 6 7 8 9 10 11 12 13 1420
25
30
35
40
45
50
55
Terri L – Triglycerides
Baseline 3-months 6-months150
170
190
210
230
250
270
Trig
lyce
rides
(m
g/dL
)
Terri L – HDL
Baseline 3-months 6-months40
42
44
46
48
50
52
54
56
58
HD
L (m
g/dL
)
Terri L – Before
Terri L – After
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1 Set 2 Set 3
Exertion Recovery Exertion Recovery Exertion Recovery
Additional (optional) Sets
Set 4 Set 5 Set 6
Exertion Recovery Exertion Recovery Exertion Recovery
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
• VO2max and pulmonary function