Aging, Exercise, and Cardiovascular Health

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Aging, Exercise, and Cardiovascular Health

• Chapter 20

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Exercise and Health

• Exercise and Aging
• Exercise and disease prevention
• CHD
• Diabetes
• Cancer
• Stroke

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Exercise and Aging

• 7-8 of adults regular vigorous exercise
• 32-36 of adults Regular low intensity exercise
  (lower than recommended)
• Exercise incidence typically ? w/ age
• More than half of individuals who begin regular
  exercise program quit within first 6 months
• Centers for Disease Control

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Exercise and Aging

• Functional capacity peaks between 20 and 30 years
  of age and decreases with advancing years.
• Active people show 25 higher functional capacity
  at any age over sedentary counterparts!
• Physical capacity will decline w/ age, but older
  people can still improve!

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Exercise and Aging

• Muscular Strength
• Peaks between 20 30 and declines approximately
  30 by age 70
• Due to reduced muscle mass (likely an actual loss
  of fibers)
• Muscles are still trainable
• ST decreases muscle protein loss
• Gains in strength () in elderly are similar to
  those seen in the young
• Increases and maintains flexibility

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Exercise and Aging

• Nervous System
• 37 decline in spinal cord axons
• 10 decline in conduction velocity
• Loss of elasticity of connective tissue
• Decreased RT and muscle contraction velocity
• Minimized by exercise
• Pulmonary Function
• Older, endurance trained individuals score
  significantly higher on PFTs

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Exercise and Aging

• Cardiovascular Function
• Aerobic capacity decreases 35 by age 65
• Hrmax declines with age (220-age)
• SV decreases
• Reduction of blood flow due to stenosis (Heart?)
• Decreased elasticity of major vessels

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Exercise and Aging

• Cardiovascular System Responds to Training at any
  AGE!!!
• Adaptations () similar to those seen in younger
  individuals.
• Decline may be 2Xs faster however.
• Body Composition
• Exercise diminishes increase in BF seen with
  aging

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Aging vs. Sedentary Lifestyle

• Aging and being sedentary combined, facilitates
  loss of physical capacity.
• Many people blame getting old for everything
  (usually lack of activity).
• Human body improves with activity...REGARDLESS OF
  AGE!!!

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Exercise to Improve Health and Extend Life

• Harvard Alumni Study (Classes of 1920 - 1954)
• Exercise improved health and reduced mortality
• Hypertensives Reduced death rate by 50
• Individuals with parents who died prior to age
  65 Reduced death rate by 25

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Harvard Alumni Study
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Exercise to Improve Health and Extend Life

• Epidemiological evidence
• Studies have shown a cause - effect relationship
  between physical inactivity and CHD (sedentary
  person 2Xs risk)
• Protective association just as strong as
  hypertension, smoking, and high cholesterol.
• Physical inactivity is the GREATEST risk factor
  for heart disease...more people are physically
  inactive than possess ALL other CHD risk factors!

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Light Activity is Valuable
Low
High
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Cardiovascular Diseases

• Cardiovascular diseases including Coronary
  Artery Disease (CAD) or Coronary Heart Disease
  (CHD), are the leading killer of Americans.
• Cardiovascular disease includes all diseases
  associated with the heart and / or blood vessels.
  

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Cardiovascular Diseases

• Cardiovascular diseases can lead to myocardial
  infarction (heart attack), stroke, embolisms,
  aneurysms, etc.
• Incidence of deaths from heart disease have
  declined since 1970 (due to advances in
  technology, not decrease in CHD incidence)
• Annual costs over 120 billion dollars!

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Cause of Death in the USA
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Coronary Artery Disease (CAD)

• Coronary circulation
• ALL blood supplied to heart is done so via two
  coronary arteries (Right Left) that bifurcate
  from the aorta just above the LV.
• There is absolutely NO blood perfusion from
  inside the chambers of the heart.
• If coronary artery is blocked, the heart may be
  starving for O2 all the while it is full of
  oxygenated blood.

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1.) Right Coronary artery 2.) Left Coronary
Artery
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Coronary Artery Disease (CAD)

• Degenerative changes involving the lining of
  major vessels supplying blood to the heart.
• Various compounds interact with these changes
  (injured areas) including the oxidative reaction
  of LDL-C to form a fatty streak.
• This is the first sign of atherosclerosis.
• Eventually a plaque is formed and the body will
  respond by generating scar tissue.

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Coronary Artery Disease (CAD)

• All of these lead to a narrowing of the CA.
• Eventually causes the myocardium (heart muscle)
  to become ischemic, or poorly supplied with
  oxygenOften associated with angina or chest
  pains.
• Blood flow may become very slow and turbulent
  causing development of a clot or thrombus.

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Myocardial Infarction

• Myocardial Infarction
• The result of inadequate perfusion of blood in
  the coronary arteries. Caused by a significant
  reduction in the diameter of the vessel (most
  often caused by a thrombus).
• Many people suffer MIs without ANY prior
  symptoms!
• Mortality rate decreases in individuals who are
  exercise trained.

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Symptoms Suggestive of CAD

• Pain or discomfort in chest, jaw, or arm
• Shortness of breath
• Dizziness
• Orthopnea (diff. Breathing when supine)
• Ankle edema (chronic)
• Claudication
• Unusual fatigue or dyspnea with light activity
• Usually,but not always experienced during
  exertion

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CAD Begins Early

• Fatty streaks are common in children as young as
  5 yrs.
• Studies examining autopsy results of Vietnam
  casualties (avg. age 19 yrs.) showed significant
  CAD in majority of men.

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Risk Factors for CAD

• Modifiable
• Obesity
• Sedentary life
• Blood lipids
• Diet
• Hypertension
• Smoking
• Diabetes
• Tension stress
• Education

• Non-Modifiable
• GENETICS
• Family History
• Race
• Sex
• Age

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Modifiable Risk Factors

• Minimizing modifiable risk factors is our best
  defense against developing CAD!
• It is impossible to weight various risk factors,
  because of the role of genetics. Some people
  simply dont develop heart disease because of the
  presence of a certain risk factor, when some one
  else may.

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Modifiable Risk Factors

• Primary Risk Factors
• Lipid levels (cholesterol)
• Blood pressure
• Smoking
• Physical Inactivity

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Modifiable Risk Factors

• Blood lipid abnormalities
• Actual mechanism is not yet fully understood
• However, strong statistical link with ? TC, ?
  LDL-C, ? HDL-C and incidence of CAD.
• TC lt 200 mg/dL
• LDL-C lt 130 mg/dL
• HDL-C gt 35 mg/dL
• TG lt 135 mg/dL (males) 160 mg/dL (females)

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Modifiable Risk Factors

• LDL-C transports cholesterol from the liver to
  the cells of the body (arteries)
• HDL-C removes cholesterol from body cells and
  transports it to the liver for excretion as bile.
• TC / HDL-C ratio is the best indicator of a
  favorable lipid profile (lt4.5)

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Modifying Blood Lipid Levels

• Favorable Effects
• Weight loss
• Exercise
• High water-soluble fiber intake
• High polyunsat. saturated fat ratio
• Intake of omega-3 fatty acids (fish)
• Moderate alcohol consumption

• Unfavorable Effects
• Smoking
• Diet high in saturated fat and cholesterol
• Stress
• Oral contraceptives
• Sedentary lifestyle

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Modifying Blood Lipid Levels

• Blood lipids are still very dependant on a
  persons genetic makeup!
• Some people respond to diet and exercise, some
  require medication.
• Lowering elevated lipids is extremely important
  for minimizing CAD risk!

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Hypertension

• Elevated blood pressure may be caused by several
  things HTN is result of either
• Excessive vasoconstrictor tone
• Arteriosclerosis hardening of arteries
• High blood volume

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Hypertension

• High blood pressure is defined as resting
  systolic gt 140 mm/Hg and/or diastolic gt 90 mm/Hg.
• Incidence increases with
• Family history
• High Na intake
• Stress
• Obesity
• Kidney ailments
• Smoking

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Hypertension

• Often called silent killer
• Most people do not know they have it
• 90 of causes are of unknown etiology (essential
  hypertension)
• Uncorrected, HT can lead to heart failure, heart
  attack, stroke, and kidney failure.
• Exercise is often the best way lower borderline
  hypertension.

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Smoking

• Increases CAD risk 2X stroke risk 5X.
• Smoking has negative effect on blood lipids and
  increases incidence of hypertension.
• Each cigarette smoked equates to a loss of seven
  minutes of life Americans loose 5 million years
  of potential life annually to smoking!

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Physical Inactivity

• Exercise protects against CAD by
• Normalizing blood lipid profile (increased HDL-C
  and lowered LDL-C)
• Lowered blood pressure and HRrest (less physical
  demand / work on myocardium)
• Improving myocardial circulation and metabolism
  (protects heart during hypoxic stress)
• Increased vascularization
• Increased glycogen stores and anaerobic capacity

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Physical Inactivity

• Exercise protects against CAD by
• Increased myocardial contractility
  vascularization
• Developing a more favorable body composition
• Decreases clot formation
• Reduces stress and tension

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Obesity

• Determining importance of obesity as a risk
  factor is difficult since it is almost always
  seen in conjunction with other risk factors.
• Overweight (gt30 BF) see a 70 increased
  mortality risk.
• Increased risk of CAD, diabetes, and stroke.

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Diabetes

• High blood glucose levels increase degeneration
  seen in vessels.
• Diabetics often have circulatory problems
  throughout the body.
• High blood sugar levels will irritate plaques in
  CA and increase likely hood of them enlarging
  and/or developing clots

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Diabetes and Exercise

• Most diabetics are Type II, adult onset.
• Exercise and obesity are the two largest risk
  factors for Type II diabetes.
• Most often caused by insulin receptor
  insensitivity (brought on by huge fluctuations in
  blood sugar)
• Most Type II diabetics can control blood glucose
  with diet and exercise and can often live
  completely free of insulin therapy.

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Stress, Tension, Type As

• Increased incidence of CAD is seen in individuals
  with high levels of stress, self reported
  tension, or who are classified as Type A
  personalities.
• RELAX!

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Non-modifiable Risk Factors

• Family History Likely the most POTENT risk
  factor!
• Age Incidence increases with age.
• Sex Females have less CAD at any given age than
  male counterparts. (Protective mechanisms of
  estrogen)
• Race Different races show different CAD rates
  (Genetics, diet, and lifestyle)

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Risk Factors (Summary)

• Age Males gt 45 yrs , Females gt 50 yrs
• Sex Males gt Females
• Family History exponentially worse if both
  parents have positive history
• Lipids
• TClt200 TGlt135 160
• HDL-C gt 35 LDL-C lt 130
• Blood Pressure lt 140 / 90 mm/Hg

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Risk Factors (Summary)

• Physical Inactivity
• Diet high in fat and cholesterol
• Smoking
• High BF (Obesity)
• Diabetes
• Stress and tension

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Interaction of Risk Factors