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Copyright © 2006 Lippincott Williams & Wilkins.

Exercise, Successful Aging, and Disease

Prevention

Exercise, Successful Aging, and Disease

Prevention Chapter 17Chapter 17


ObjectivesObjectives• Describe what the term “healthspan” means• Explain the concept of successful aging

compared to traditional views of the aging process

• Explain the basis of the Physical Activity Pyramid

• Answer the question: “How safe is exercise?”• Describe the goals of Healthy People 2010• What is SEDS, and why is it important?


Objectives (cont’d)Objectives (cont’d)

• List important age-related changes in: (1) muscular strength, (2) joint flexibility, (3) nervous system function, (4) cardiovascular function, (5) pulmonary function, and (6) endocrine function and body composition

• Describe five field tests to assess flexibility of major body areas

• Describe research showing regular physical activity protects against disease and may even extend life



• List the three major causes of death in the United States

• List and describe the four major coronary heart disease risk factors

• List secondary and novel risk factors for coronary heart disease

• List specific components of the blood lipid profile, and give values considered desirable for each

• Discuss factors that affect cholesterol lipoprotein levels



• Explain how regular physical activity reduces coronary heart disease risk

• Describe the occurrence of CHD risk factors in children

• Explain interactions between CHD risk factors


The Graying of AmericaThe Graying of America

• Elderly persons make up the fastest growing segment of America

• ~35 million Americans exceed age 65

• By the year 2030, 70 million Americans will exceed age 85


Successful AgingSuccessful Aging

• Requires maintenance of enhanced:– Physiologic function– Physical fitness

• Components of successful aging– Physical health– Spirituality– Emotional and educational health– Social satisfaction


Physical Activity and AgingPhysical Activity and Aging

• Physical activity attenuates the impact that “normal aging” has on:– Blood pressure– Body composition– Insulin sensitivity– Bone mass


HealthspanHealthspan

• The total number of years a person remains in excellent health


Healthy Life ExpectancyHealthy Life Expectancy

• The expected number of years a person might live in the equivalent of full health

• Disability-adjusted life expectancy– Considers the years of ill health,

weighted according to severity and subtracted from expected overall life expectancy to compute the equivalent years of healthy life


Years of Life Lost (YLL)Years of Life Lost (YLL)

• Most prominent factors responsible for decreased life expectancy in non-Western countries include:– Low birth weight– Vitamin/mineral deficiency– Unsafe water/sanitation procedures– Unsafe sex – HIV– Introduction of carcinogens– Work-related risk


Years of Life Lost (YLL) (cont’d)

Years of Life Lost (YLL) (cont’d)• Most prominent factors responsible for

decreased life expectancy in Western countries include:– Tobacco use– High blood pressure– Increased cholesterol– Obesity– Low levels of physical activity– Low levels of fruit and vegetable

consumption


Physical Activity Participation

Physical Activity Participation

• Only 15% of Americans engage in regular vigorous physical activity

• >60% of Americans do not engage in any regular physical activity

• 25% of Americans lead sedentary lives

• Participation in fitness activity declines with age


Healthy People 2010Healthy People 2010

• Primary aims– Increase quality and years of healthy life– Eliminate health disparities among the

nation’s citizens


Exercise and Sudden DeathExercise and Sudden Death

• Heavy physical exertion poses a small risk of sudden death during the activity

• ~1 sudden death per 1.5 million exercise episodes of exertion

• However, the longer term reduction in overall death risk from regular physical exercise outweighs the small potential for acute cardiovascular complications


Sedentary Environmental Death Syndrome (SeDS)Sedentary Environmental Death Syndrome (SeDS)

• Physical inactivity produces a constellation of problems and conditions that lead to premature death

• The term Sedentary environmental Death Syndrome, coined by Frank Booth, identifies this deleterious condition

• http://hac.missouri.edu


Sedentary Environmental Death Syndrome (SeDS)

(cont’d)

Sedentary Environmental Death Syndrome (SeDS)

(cont’d)• SeDS will cause 2.5 million

Americans to die prematurely in the next decade

• SeDS will cost $2 to $3 trillion in health expenses in the United States in the next decade

• SeDS is related to 23 medically related conditions: e.g., obesity, high blood pressure, insulin resistance


Aging and Muscular Strength

Aging and Muscular Strength

• Men and women achieve maximum strength between the ages of 20 and 30 years

• Thereafter, strength progressively declines for most muscle groups

• By age 70, overall strength decreases by ~30%


SarcopeniaSarcopenia

• Refers to a decrease in muscle mass associated with aging


Muscle Trainability Among the Elderly

Muscle Trainability Among the Elderly

• Regular exercise training retains body protein and blunts the loss of muscle mass and strength with aging


Aging and Joint FlexibilityAging and Joint Flexibility

• With advancing age, connective tissue becomes stiffer and more rigid, which reduces joint flexibility

• Regularly moving joints through their full range of motion increases flexibility by 20 to 50%


Aging and Endocrine Changes

Aging and Endocrine Changes

• Endocrine function changes with age, particularly the pituitary, pancreas, adrenal, and thyroid glands


Impaired Glucose Metabolism

Impaired Glucose Metabolism

• Factors contributing to age-associated impairments in glucose metabolism include:– Insulin resistance– Relative insulin deficiency– Combined effect of insulin resistance

and relative insulin deficiency


Aging and Thyroid Dysfunction

Aging and Thyroid Dysfunction

• Thyroid dysfunction commonly occurs in the elderly as a result of:– Lowered pituitary gland secretion of

thyroid-stimulating hormone– Reduced output of thyroxine by the

thyroid gland


Aging and the Hypothalamic-Pituitary-

Gonadal Axis

Aging and the Hypothalamic-Pituitary-

Gonadal Axis• Aging is associated with altering

interactions between hypothalamic releasing hormones and the anterior pituitary gland and gonads

• Menopause and andropause reflect the gender-specific manifestations of these altered interactions


Adrenal CortexAdrenal Cortex

• Adrenopause– Refers to the significant decrease in

output of dehydroepiandrosterone (DHEA) and its sulfated ester (DHEAS) from the adrenal cortex

– DHEA declines progressively after the age of 30


Growth Hormone/Insulin-Like Growth Factor 1 AxisGrowth Hormone/Insulin-Like Growth Factor 1 Axis

• Somatopause– Refers to the age-associated reduction

in mean pulse amplitude, duration, and fraction of secreted growth hormone (GH)

– A concomitant decrease in circulating insulin-like growth factor (IGF) 1 also occurs


Aging and Nervous System Function

Aging and Nervous System Function

• Aging per se is associated with– 37% decline in the number of spinal axons– 10% decline in nerve conduction velocity– Impairments in neuromuscular performance

• Regular physical activity may attenuate the age-associated declines in neuromuscular performance


Aging and Pulmonary Function

Aging and Pulmonary Function

• Aging per se is associated with– A decline in pulmonary function

• Regular physical activity may attenuate the age-associated declines in pulmonary function


Aging and Cardiovascular Function

Aging and Cardiovascular Function

• Maximal oxygen uptake ( O2max) declines steadily after the age of 20

• A slower rate of decline occurs for individuals who maintain an active lifestyle that includes regular aerobic exercise training

• Physical activity, however, does not entirely offset aging’s effect on O2max

V

V


Aging and Cardiovascular Function (cont’d)

Aging and Cardiovascular Function (cont’d)

• Skeletal muscle oxidative capacity and capillarization remain similar in older and younger individuals with comparable training history

• Thus, age-associated reduction in cardiac output represents the most likely explanation for the decrease in O2max per kg of active muscle that accompanies aging

V


Aging Response to Exercise Training

Aging Response to Exercise Training

• For the healthy elderly, exercise training enhances the heart’s capacity to pump blood and increases aerobic capacity to the same degree as in younger adults


Aging and Body Composition

Aging and Body Composition

• Aging per se is associated with:– A decline in fat-free mass (FFM)– An increase in fat mass (FM)– A preferential deposition of fat into the

abdominal visceral fat depot• Regular physical activity may

attenuate the age-associated decline in FFM, while depressing the age-associated increase in FM


Benefits of Regular ExerciseBenefits of Regular Exercise

• Regular physical activity and exercise attenuates the risks associated with:– Smoking– Obesity– Diabetes– Hypertension– Coronary heart disease


Coronary Heart Disease (CHD)

Coronary Heart Disease (CHD)

• The leading cause of death in America

• Involves degenerative changes in the intima or inner lining of the larger arteries that supply the myocardium


Gender Differences and CHD

Gender Differences and CHD

• CHD symptoms, progression, and outcomes differ by gender– Women usually die sooner following a

heart attack– Women who survive a heart attack

frequently experience a second episode– Women become more incapacitated by

heart disease-related pain and disability– Women are less likely to survive

coronary artery bypass surgery


Myocardial Infarctions (MI)Myocardial Infarctions (MI)

• Are caused by:– A blockage in one or more of the

coronary vessels, which causes tissue necrosis from lack of oxygen

– Sudden spasms (constrictions) of a coronary vessel, which causes tissue necrosis from lack of oxygen


Angina PectorisAngina Pectoris

• Chest pain due to an inadequate myocardial perfusion

• Usually emerges during periods of exertion, which increases myocardial oxygen demand


Modifiable CHD Risk FactorsModifiable CHD Risk Factors

• Cigarette smoking• Hypercholesterolemia• Diabetes mellitus• Hypertension


Cigarette Smoking and CHDCigarette Smoking and CHD

• Both active and passive smoking increase CHD risk

• Smokers experience twice the risk of death from CHD compared to nonsmokers


Lifestyle and LipoproteinsLifestyle and Lipoproteins

• Factors favorably affecting cholesterol and lipoprotein levels include:– Weight loss– Regular aerobic exercise– Increased water-soluble fiber– Increased dietary intake of

polyunsaturated to saturated fatty acid ratio and monounsaturated fats


Lifestyle and Lipoproteins (cont’d)


• Factors favorably affecting cholesterol and lipoprotein levels include:– Increased dietary intake of omega-2

fatty acids– Moderate alcohol consumption




• Factors negatively affecting cholesterol and lipoprotein levels include:– Cigarette smoking– Diet high in saturated fatty acids and

preformed cholesterol– Emotionally stressful situations– Certain oral contraceptives


Hypertension and CHDHypertension and CHD

• More than 35 million Americans have hypertension (SBP > 140 or DBP > 90)

• Uncontrolled hypertension can precipitate:– Heart failure– Heat attack– Stroke– Kidney failure


Diabetes and CHDDiabetes and CHD

• Diabetics are two to four times more likely to develop cardiovascular disease

• Risk factors coincident with diabetes include:– Obesity– Physical inactivity– Hypertension– Atherogenic dyslipidemia


Other CHD Risk FactorsOther CHD Risk Factors

• Age• Gender• Heredity• Immunologic

factors• Homocysteine• Excessive body

fat

• Physical inactivity• C-reactive

protein• Lipoprotein(a)

[Lp(a)]• Fibrinogen