Physiological aging Physiological aging process &role of process &role of

exerciseexercise

Dr_R.heidari Dr_R.heidari moghadammoghadam (MD&PhD) (MD&PhD)

Exercise physiologistExercise physiologist

DEFINITION OF AGINGDEFINITION OF AGING

Old and aging depends on the age Old and aging depends on the age and experience of the speaker.and experience of the speaker.

Chronological age - number of Chronological age - number of years livedyears lived

Physiologic age - age by body Physiologic age - age by body functionfunction

Functional age - ability to Functional age - ability to contribute to societycontribute to society

CHRONOLOGICAL CHRONOLOGICAL CATEGORIESCATEGORIES

Young-Old - (ages 65 - 74)Young-Old - (ages 65 - 74)

Middle-Old - (ages 75 - 84)Middle-Old - (ages 75 - 84)

Old-Old - (age 85 and olderOld-Old - (age 85 and older))

PHYSIOLOGICAL PHYSIOLOGICAL THEORIES OF THEORIES OF

AGINGAGING

What causes the body to What causes the body to age?age?

PROGRAM THEORYPROGRAM THEORY

CellsCells replicate a specific replicate a specific number of times and then number of times and then die. Happens again, and die. Happens again, and again in lab experiments.again in lab experiments.

ERROR THEORYERROR THEORY

The structure of DNA The structure of DNA is altered as people is altered as people ageage

Due to alterations, Due to alterations, DNA not read correctlyDNA not read correctly

Results in Results in transcription and transcription and translation translation malfunctionmalfunction

Results in Results in aging/illness/ cancer aging/illness/ cancer directly, or indirectlydirectly, or indirectly

CELLULAR THEORYCELLULAR THEORY

Normal wear and tear Normal wear and tear causes cells to function causes cells to function

improperlyimproperly

FREE RADICAL THEORYFREE RADICAL THEORY

Lipids in cell Lipids in cell membranes are membranes are exposed to exposed to radiation or free radiation or free radicalsradicals

Cell membrane Cell membrane ruptures ruptures and cell and cell diesdies

In test tubes this In test tubes this actually occursactually occurs

NUTRITIONAL MODEL NUTRITIONAL MODEL THEORYTHEORY

If animal fed 50-If animal fed 50-60% less than it 60% less than it eats on its own - eats on its own - lives longerlives longer

Assumption: Lean Assumption: Lean mass, as opposed mass, as opposed to adipose tissue to adipose tissue results in greater results in greater healthhealth

COLLAGEN THEORY OF AGINGCOLLAGEN THEORY OF AGING

As we age, As we age, collagencollagen in in body ages also. Causesbody ages also. Causes hypertension hypertension and other and other

organ malfunctionsorgan malfunctions

MUTATING AUTO-IMMUNE MUTATING AUTO-IMMUNE THEORYTHEORY

Cells have normal functions - Cells have normal functions - secrete normal proteinssecrete normal proteins

As cells age - mutate and As cells age - mutate and secretions viewed as foreign by secretions viewed as foreign by bodybody

Solicits immune responseSolicits immune response Shuts cell downShuts cell down Cause biological errors and entire Cause biological errors and entire

organ malfunctionsorgan malfunctions

NEURO-AGING THEORYNEURO-AGING THEORY

All cells undergo All cells undergo nervous system nervous system degenerationdegeneration

Results in Results in changes in changes in hormonal releasehormonal release

Leads to decline Leads to decline in cell functionin cell function

NONE OF THESE NONE OF THESE THEORIES THEORIES TOTALLY TOTALLY

ACCEPTEDACCEPTEDScientists hypothesize it Scientists hypothesize it might be combination of might be combination of

several or allseveral or all

PHYSIOLOGICAL AGING PHYSIOLOGICAL AGING OF THE HUMAN BODY OF THE HUMAN BODY

BY SYSTEMSBY SYSTEMS

RESPIRATORY RESPIRATORY SYSTEMSYSTEM

Lungs become more Lungs become more rigidrigid

Pulmonary function Pulmonary function decreasesdecreases

Number and size of Number and size of alveoli decreasesalveoli decreases

Vital capacity declinesVital capacity declines Reduction in Reduction in

respiratory fluidrespiratory fluid Bony changes in chest Bony changes in chest

cavitycavity

CARDIOVASCULAR CARDIOVASCULAR SYSTEMSYSTEM

Heart smaller and less Heart smaller and less elastic with ageelastic with age

By age 70 cardiac output By age 70 cardiac output reduced 70%reduced 70%

Heart valves become Heart valves become scleroticsclerotic

Heart muscle more Heart muscle more irritableirritable

More arrhythmiasMore arrhythmias Arteries more rigidArteries more rigid Veins dilateVeins dilate

REPRODUCTIVE SYSTEMREPRODUCTIVE SYSTEM

Male:Male: Reduced testosterone levelReduced testosterone level Testes atrophy and softenTestes atrophy and soften Decrease in sperm Decrease in sperm

productionproduction Seminal fluid decreases Seminal fluid decreases

and more viscousand more viscous Erections take more timeErections take more time Refractory period after Refractory period after

ejaculation may lengthen ejaculation may lengthen to daysto days

REPRODUCTIVE SYSTEMREPRODUCTIVE SYSTEM

Female:Female: Declining estrogen and Declining estrogen and

progesterone levelsprogesterone levels Ovulation ceasesOvulation ceases Introitus constricts Introitus constricts

and loses elasticityand loses elasticity Vagina atrophies - Vagina atrophies -

shorter and driershorter and drier Uterus shrinksUterus shrinks Breasts pendulous and Breasts pendulous and

lose elasticitylose elasticity

NEUROLOGICAL SYSTEMNEUROLOGICAL SYSTEM

Neurons of central and Neurons of central and peripheral nervous system peripheral nervous system degeneratedegenerate

Nerve transmission slowsNerve transmission slows Hypothalamus less effective in Hypothalamus less effective in

regulating body temperatureregulating body temperature Reduced REM sleep, decreased Reduced REM sleep, decreased

deep sleepdeep sleep After 50% lose 1% of neurons After 50% lose 1% of neurons

each yeareach year

MUSCULOSCELETAL MUSCULOSCELETAL SYSTEMSYSTEM

Adipose tissue increases with Adipose tissue increases with ageage

Lean body mass decreasesLean body mass decreases Bone mineral content Bone mineral content

diminisheddiminished Decrease in height from Decrease in height from

narrow vertebral spacesnarrow vertebral spaces Less resilient connective Less resilient connective

tissuetissue Synovial fluid more viscousSynovial fluid more viscous May have exaggerated May have exaggerated

curvature of spinecurvature of spine

Exercise and Exercise and AgingAging

GoalsGoals

Develop an understanding of normal Develop an understanding of normal aging physiologyaging physiology

Incorporate aerobic and resistance Incorporate aerobic and resistance exercise into treatment and exercise into treatment and prevention plans of the elderlyprevention plans of the elderly

Appropriate pre-exercise assessmentAppropriate pre-exercise assessment

Exercise and Exercise and aging physiologyaging physiology

Physiologic changes with Physiologic changes with aging (Board Questions)aging (Board Questions)

Decreased Decreased Muscle massMuscle mass Muscle strengthMuscle strength Muscle powerMuscle power Muscle enduranceMuscle endurance Muscle contraction Muscle contraction

velocityvelocity Muscle Muscle

mitochondrial mitochondrial functionfunction

Muscle oxidative Muscle oxidative enzyme capacityenzyme capacity

Physiologic changes with Physiologic changes with aging (Board Questions)aging (Board Questions)

DecreasedDecreased Maximal and Maximal and

submaximal aerobic submaximal aerobic capacitycapacity

Cardiac contractilityCardiac contractility Maximal heart rateMaximal heart rate Stroke volume and Stroke volume and

cardiac outputcardiac output Nerve conduction Nerve conduction

velocityvelocity BalanceBalance

DecreasedDecreased ProprioceptionProprioception Gait velocityGait velocity Gait stabilityGait stability Insulin sensitivityInsulin sensitivity Glucose toleranceGlucose tolerance Immune functionImmune function Bone Bone

mass/strength/densitymass/strength/density Collagen cross-linkage, Collagen cross-linkage,

thinning cartilage, thinning cartilage, tissue elasticitytissue elasticity

Physiologic QuestionsPhysiologic Questions

IncreasedIncreased Arterial stiffnessArterial stiffness Myocardial stiffnessMyocardial stiffness Systolic blood Systolic blood

pressurepressure Diastolic blood Diastolic blood

pressurepressure Visceral fat massVisceral fat mass Total body fatTotal body fat Intramuscular lipid Intramuscular lipid

accumulationaccumulation

Use It or Lose ItUse It or Lose It

Sedentary people lose large amounts of Sedentary people lose large amounts of muscle mass (20-40%)muscle mass (20-40%)

6% per decade loss of Lean Body Mass 6% per decade loss of Lean Body Mass (LBM)(LBM)

Aerobic activity not sufficient to stop this Aerobic activity not sufficient to stop this lossloss

Only resistance training can overcome this Only resistance training can overcome this loss of mass and strengthloss of mass and strength

Balance and flexibility training contributes Balance and flexibility training contributes to exercise capacityto exercise capacity

What is exercise?What is exercise?

Lifestyle choicesLifestyle choices Organized sportsOrganized sports Unstructured playUnstructured play Household and Household and

Occupational tasksOccupational tasks

Increased Muscle MassIncreased Muscle Mass Endurance training Endurance training

emphasisemphasis Walking isn’t enoughWalking isn’t enough

Progressive Progressive resistance trainingresistance training DM prevention?DM prevention? Dependency Dependency

prevention?prevention? Falls and fracturesFalls and fractures DisuseDisuse SarcopeniaSarcopenia FrailtyFrailty

Use It and Lose Less of ItUse It and Lose Less of It

Resistance training improves strength by a Resistance training improves strength by a range of range of

40-150%40-150% Lean body mass increases 1-3 kgLean body mass increases 1-3 kg Muscle fiber area 10-30%Muscle fiber area 10-30%

Body compositionBody composition

Genetic, lifestyle Genetic, lifestyle and disease factorsand disease factors

Metabolic, Metabolic, cardiovascular and cardiovascular and musculoskeletal musculoskeletal systems impactedsystems impacted

Lifestyle is under Lifestyle is under patient’s controlpatient’s control

Weight Weight manangementmanangement

Burning FatBurning Fat

Decreases in total body adipose Decreases in total body adipose tissuetissue Aerobic and resistive trainingAerobic and resistive training Energy restricted diets and/or high Energy restricted diets and/or high

volume exercise (5-7 hours/week)volume exercise (5-7 hours/week) Visceral fat selectively mobilizedVisceral fat selectively mobilized

What’s What’s fatfat got to do with got to do with it?it?

Metabolic syndromeMetabolic syndrome Vascular diseaseVascular disease OsteoarthritisOsteoarthritis Gallbladder diseaseGallbladder disease DiabetesDiabetes HypertensionHypertension DyslipidemiaDyslipidemia Sleep apneaSleep apnea

Breast cancerBreast cancer Colon cancerColon cancer Endometrial Endometrial

cancercancer ImpotenceImpotence OsteoarthritisOsteoarthritis DepressionDepression DisabilityDisability

Exercise and preventionExercise and prevention

Diabetes and Diabetes and OsteoporosisOsteoporosis

Insulin Resistance Insulin Resistance Improves insulin sensitivityImproves insulin sensitivity Detraining may reduce exercise effectDetraining may reduce exercise effect Primary prevention demonstratedPrimary prevention demonstrated

Osteoporosis prevention and treatmentOsteoporosis prevention and treatment Stabilization or increase in bone density in Stabilization or increase in bone density in

pre- and postmenopausal women with pre- and postmenopausal women with resistive or weight bearing exerciseresistive or weight bearing exercise

1-2% per year difference from controls1-2% per year difference from controls

DyslipidemiaDyslipidemia

Not a lot of data in elderlyNot a lot of data in elderly No clear primary and secondary prevention No clear primary and secondary prevention

datadata Exercise associated with less atherogenic Exercise associated with less atherogenic

profilesprofiles Duration and frequency factorsDuration and frequency factors Weight loss (or fat loss) associated with Weight loss (or fat loss) associated with

increased HDLincreased HDL Gender differences with trainingGender differences with training

Less training effect on HDL in womenLess training effect on HDL in women

HypertensionHypertension

Most trials cross sectional and cohortMost trials cross sectional and cohort Lower pressures in active individualsLower pressures in active individuals

5-10 mmHg5-10 mmHg Type and intensityType and intensity

Greater training effect in those with Greater training effect in those with mild to moderate hypertension mild to moderate hypertension 6-7 mmHg drop in systolic and diastolic 6-7 mmHg drop in systolic and diastolic

pressurepressure Effect present in low-to-moderate exerciseEffect present in low-to-moderate exercise

CVDCVD

Exercise training beneficial in CVDExercise training beneficial in CVD Reduced claudication painReduced claudication pain Greater walking distanceGreater walking distance Improved functional endpointsImproved functional endpoints

Benefit in selected patients with Benefit in selected patients with coronary artery diseasecoronary artery disease..

ArthritisArthritis

Improved functional statusImproved functional status Faster gaitFaster gait Lower depressionLower depression Less painLess pain Less medication useLess medication use Strength and endurance training Strength and endurance training

benefitbenefit

CancerCancer

Potential protective benefits with Potential protective benefits with Breast CancerBreast Cancer Colon CancerColon Cancer ProstatProstat

Exercise treatment of Exercise treatment of chronic diseasechronic disease

May treat symptoms and disuse and May treat symptoms and disuse and not the underlying diseasenot the underlying disease Parkinson’sParkinson’s COPDCOPD ClaudicationClaudication Chronic renal failureChronic renal failure

May reduce recurrence of diseaseMay reduce recurrence of disease CVDCVD FallsFalls

Exercise and Exercise and emotional health emotional health and well beingand well being

Emotional well beingEmotional well being

Genetic, social, Genetic, social, personality, and personality, and psychological psychological constructsconstructs

Leading cause of Leading cause of death and death and disability in disability in developed developed countriescountries

Exercise and Mental Exercise and Mental HealthHealth

Positive psychologic attributesPositive psychologic attributes Lower prevalence and incidence of Lower prevalence and incidence of

depressive symptomsdepressive symptoms Reversal of hippocampal volume loss?Reversal of hippocampal volume loss? Reversal of cognitive loss?Reversal of cognitive loss? 14 randomized, controlled trials:14 randomized, controlled trials:

Aerobic and resistance trainingAerobic and resistance training Higher intensitiesHigher intensities Meaningful improvements in depressionMeaningful improvements in depression Response rates of 31-88%Response rates of 31-88% Equipotent to standard treatmentEquipotent to standard treatment

Exercise and Exercise and disabilitydisability

Function relates to Function relates to strengthstrength

Non-linear relationship between strength Non-linear relationship between strength and functionand function Concept of ThresholdConcept of Threshold

EPESE Study:EPESE Study: Physically active patients at baseline less Physically active patients at baseline less

likely to develop disabilitylikely to develop disability Exercise improves functional limitationsExercise improves functional limitations

Functional balance tasksFunctional balance tasks Gait speedGait speed ArthritisArthritis

Exercise and longevityExercise and longevity

Exercise Exercise EvaluationEvaluation

ContraindicationsContraindications

Relative Relative Acute illnessAcute illness Undiagnosed chest Undiagnosed chest

painpain Uncontrolled diabetesUncontrolled diabetes Uncontrolled Uncontrolled

hypertensionhypertension Uncontrolled asthmaUncontrolled asthma Uncontrolled CHFUncontrolled CHF Musculoskeletal Musculoskeletal

problemsproblems Weight loss and fallsWeight loss and falls

AbsoluteAbsolute Inoperable Aortic Inoperable Aortic

AneurysmAneurysm Cerebral aneurysmCerebral aneurysm Malignant Malignant

ventricular ventricular arrhythmiaarrhythmia

Critical aortic Critical aortic stenosisstenosis

End-stage CHFEnd-stage CHF Terminal illnessTerminal illness Behavioral problems Behavioral problems

Exercise PrescriptionExercise Prescription ModesModes

General activitiesGeneral activities AerobicAerobic

WalkingWalking SportsSports

ResistanceResistance Supervision/Supervision/

techniquetechnique Benefit with one setBenefit with one set

FlexibilityFlexibility Static stretchStatic stretch

BalanceBalance Risk assessmentRisk assessment Dynamic and static Dynamic and static

balancebalance

Mode governed by:Mode governed by: DurationDuration

30 minutes30 minutes FrequencyFrequency

Most daysMost days IntensityIntensity

Borg Scale 12-14Borg Scale 12-14 55-75% of MHR55-75% of MHR

MHRMHR

ACSM guidelines for ACSM guidelines for healthy aerobic activityhealthy aerobic activity

Exercise 3-5 days each weekExercise 3-5 days each week Warm up 5-10 minutes before aerobic Warm up 5-10 minutes before aerobic

activityactivity Maintain intensity for 30-45 minutesMaintain intensity for 30-45 minutes Gradually decrease intensity of Gradually decrease intensity of

workout, then stretch to workout, then stretch to cool down cool down during last 5-10 minutesduring last 5-10 minutes

If weight loss is goal, If weight loss is goal, 30 minutes 30 minutes five five days a weekdays a week

Aging and Aerobic Aging and Aerobic CapacityCapacity

Peak between 15-30Peak between 15-30 Declines with ageDeclines with age Approximately 10% per decade after Approximately 10% per decade after

age 25-30age 25-30 Masters Athletes: 5% per decadeMasters Athletes: 5% per decade Overall: 0.55 decline per year in VO2 Overall: 0.55 decline per year in VO2

maxmax Anaerobic threshold: occurs at lower Anaerobic threshold: occurs at lower

work rateswork rates

Benefits of Regular Physical Benefits of Regular Physical ActivityActivity

Cardiovascular healthCardiovascular health

Cholesterol, HDL, LDL, VO2,RHRCholesterol, HDL, LDL, VO2,RHR

Muscular healthMuscular health

Strengthens boneStrengthens bone

LBM enhanced/preservedLBM enhanced/preserved

BMR improved/maintainedBMR improved/maintained

Endurance/strength improvesEndurance/strength improves

More Benefits of Regular Physical Activity More Benefits of Regular Physical Activity

Reduces health risks associated with Reduces health risks associated with obesityobesity Enhances insulin actionEnhances insulin action Reduces body fatReduces body fat

Reduces cancers risk Reduces cancers risk Reduces susceptibility to infectionsReduces susceptibility to infections Improves peristaltic functionsImproves peristaltic functions Fewer injuriesFewer injuries Reduced health care costsReduced health care costs Psychological healthPsychological health

Stress and depressionStress and depression Improved QOLImproved QOL

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