SlideShare a Scribd company logo
1 of 37
Download to read offline
Exercise in Older Adults
Dr Jason Kaplan
June 2013
Exercise in Older
Adults
The benefits of middle age fitness
• Arch Int Med 2012 University of Texas
• Age 49 EST / 5 categories /1970– Most to least
( majority ) Cooper Clinic
• RV records from 1999-2009
• Adults least fit at Middle age checkup most
likely to develop chronic disease at earlier age
heart diabetes, cancer
• Most fit – some still developed but later in life
– ie lived with chronic disease later in life for
shorter time periods
• “ lenghthening of Morbidity “
• “ The Fit live well ! “
Invasion of the MAMILS !
Exercise in Older Adults
Exercise in Older Adults
Exercise in Older Adults
METS
Activity METS
Slow walk 2-3
Golf 3-5
Fast walk / tennis doubles 4-5
Hiking 6-7
Dancing, rowing 6-7
Bicycle, swimming 6-10
Singles Tennis 7-12
Running 10 km /hr 10
Running 15 km/hr 16
MET- 3.5 mL O2 uptake
/kg/min = resting oxygen
uptake in sitting position
Myers J et al. N Engl J Med 2002;346:793-801
Relative Risks of Death from Any Cause among Subjects with Various Risk Factors Who
Achieved an Exercise Capacity of Less Than 5 MET or 5 to 8 MET, as Compared with Subjects
Whose Exercise Capacity Was More Than 8 METS
Myers J et al. N Engl J Med 2002;346:793-801
Age-Adjusted Relative Risks of Death from Any Cause According to Quintile of Exercise Capacity
among Normal Subjects and Subjects with Cardiovascular Disease
Exercise in Older Adults
CAD in older athletes
• Routine physical exercise is associated with
reduced morbidity and mortality from CAD,
but vigorous physical exertion also transiently
increases the risk of both acute myocardial
infarction (MI) and SCD.
• In most cases, the risk to asymptomatic
individuals without prior atherosclerotic
disease is small.
CAD older athletes
• athletes with established CAD remain at some
increased risk for SCD or MI, and any CAD risk
factors should be vigorously treated.
• Regular physical exercise improves an
individual’s CV risk profile and reduces CVD
morbidity and mortality.
• vigorous exercise also increases the short-
term risk of coronary events and sudden
death by 5- to 7-fold compared to rest.
Who Needs An EST prior to vigorous
Exercise
• The American College of Cardiology and American
Heart Association recommend exercise treadmill
testing for asymptomatic patients with diabetes
mellitus, men older than 45 years of age, and
women older than 55 years of age before they
undertake vigorous exercise, with the decision to
incorporate myocardial imaging based on the
baseline ECG and pre-test probability of CAD
• Level of evidence B
2010 ACCF/AHA Guideline for Assessment of
Cardiovascular Risk in Asymptomatic Adults
• 1. An exercise ECG may be considered for
cardiovascular risk assessment in
intermediate-risk asymptomatic adults
(including sedentary adults considering
starting a vigorous exercise program), par-
ticularly when attention is paid to non-ECG
markers such as exercise capacity.
The EST – Key points
• - doesn’t predict SCD or MI ( CACS better ) –
rupture non stenotic plaque
• Useful in risk after event/ revasc ie BP/ He,
rythym
• HR and BP response important
• Exercise not hand grip
• Exercise duration predicts survival
• Talk test vs age regression ( 220 – age X 70-
80%)
Watch these People
• Uncontrolled SBP > 160 at rest ( BP will to rise
with exercise )
• Active Symptoms( CP, SOB, Palp, Syncope)
• Strong Family History – those over age 50
• Poorly controlled lipids
• Any exercise induced symptom is significant
Cardiovascular risk stratification for
exercise
• AHA ( prob outdated )
• Class A- healthy,no clinical evidence of inc CVS
Risk
• Class B - established CHD- LOW RISK
• Class C- mod/high risk/ previous events
• Class D- contraindicated
• MET- 3.5 mL O2 uptake /kg/min = resting
oxygen uptake in sitting position.
Exercise in Older Adults
Class A
• Lets talk about it !
Exercise in Older Adults
Exercise in Older Adults
Exercise in Older Adults
Older Athletes
• Masters Athletes
• Age varies by sport
– Generally over 40 years of age
• Organized sports that require systematic
training for competition
• General use – synonym for “older athlete”
• Masters Athletes – Aging Well
• Declines in athletic performance inevitable
with aging
• Peak endurance performance maintained to
age 35
• Modest decreases to age 50-60
Progressively steeper declines > age 60
• Tanaka H, Seals DR. Endurance exercise performance in Masters athletes. J Physiol. 2008 Jan 1;586(1):55-63.
• Masters Athletes – Aging Well
• 3 main physiological determinants of reduction
– Lactate threshold reduced
– Exercise economy stable
– Maximal oxygen consumption
• Decreases in maximal stroke volume, heart rate,
& AV O2 difference
• Reduced intensity & volume in training sessions
• Prolonged Endurance Exercise
• 25 healthy 51-59 yo volunteers (21 males) from
2010 & 11 Manitoba Marathons
• Assessed
Cardiac biomarkers & TTE assessed 1 wk prior to,
immediately after & 1 wk after the marathon
– CMR was performed at baseline & within 24 hrs of
marathon completion
CCT within 3 months of marathon
– Karlstedt E, et al. The impact of repeated marathon running on cardiovascular function in the aging population. J Cardiovasc Magn Reson. 2012;14(1):58.
• Prolonged Endurance Exercise
– All participants demonstrated an elevated cTnT,
RA & RV volumes post marathon
– RV systolic function decreased significantly
immediately post marathon
• Returned to baseline 1 week later
– Marathon associated with transient, reversible
increase in cardiac biomarkers & RV systolic
dysfunction
• Long Term Marathon Running
• 26 women ≥ 10 annual marathons (n=26)
– Less coronary plaque prevalence (19 vs. 50%)
– Less calcific plaque volume (43 vs. 77 mm3)
• 50 men ≥ 25 annual marathons (n=50)
– Similar plaque prevalence
– Increased total plaque volume (200 vs. 126 mm3,
– p<0.01), calcified plaque volume (84 vs. 44 mm3,
p<0.0001), & non-calcified plaque volume (116 vs. 82,
p=0.04)
• All significantly lower resting HR, body mass, BMI, & TG
levels & higher HDL cholesterol levels
• Long Term Marathon Running
– Compared to a control population
• Men running marathons for longer time
– Paradoxically increased coronary plaque volume &
prevalence
– Women had lower coronary artery plaque
prevalence & less calcified plaque volume
• Schwartz RS, et al. Coronary Artery Plaque in Long Term Marathon Runners Assessed by High Resolution CCTa.
(unpublished data)
Why Inc Risks
• Arterial stiffness ( PWA- Sphygmacor) higher in
marathon runners
• Atrial remodelling and atrial arrhythmias
• Increased pro- inflammatory markers – Il 6 ,
TNF, Chromagraffin A, CRP
• Marathon Study
• Statins also seem to increase risks muscle
related injury
Older age/ Endurance Key Points
• Marathon running is associated with a small
increased incidence of SCD, which is
dependent on age, sex, and training status.
(The risk from a half-marathon is significantly
less.)
• Myocardial hypertrophy and coronary
ischemia are the fundamental
pathophysiologic entities, with the former
more likely to be fatal.
• Despite a significantly more favorable CV risk
profile in marathon runners, coronary
calcification and myocardial injury are
relatively common and seen more frequently
than in a control population of non-runners.
Take HOME POINTS CAD older
athletes
• It is important to know how important exercise is to
the individual patient: “Some people are hooked on
it and it is very important to their lives.”
• we know their risk of coronary events increases
during intense activity. It’s not possible to precisely
determine this increased risk, but it is greater than at
rest.
• “Treat risk factors aggresively especially their lipids.”
Hopefully, intensive lipid-lowering will stabilize their
plaques and permit them to continue their chosen
activity.
• Warning: some patients think that because they are
in good shape and run marathons, they do not have
to take cholesterol-lowering therapy. You are most
likely to see this in people with risk factors who want
to ignore them.
Message from British Heart Foundation

More Related Content

What's hot

Physical activity in people with disabilities and elderly people
Physical activity in people with disabilities and elderly peoplePhysical activity in people with disabilities and elderly people
Physical activity in people with disabilities and elderly peopleKarel Van Isacker
 
exercise prescription
exercise prescriptionexercise prescription
exercise prescriptionstewartbovis
 
Physiotherapy assessment of cardiac conditions
Physiotherapy assessment of cardiac conditionsPhysiotherapy assessment of cardiac conditions
Physiotherapy assessment of cardiac conditionsBPT4thyearJamiaMilli
 
Exercise for special populations
Exercise for special populationsExercise for special populations
Exercise for special populationsSprint College
 
Diabetes Mellitus and Physical Therapy
Diabetes Mellitus and Physical Therapy Diabetes Mellitus and Physical Therapy
Diabetes Mellitus and Physical Therapy Prochnost
 
Exercise Physiology In Pediatrics
Exercise Physiology In PediatricsExercise Physiology In Pediatrics
Exercise Physiology In PediatricsApeksha Besekar
 
Epidemiology impact of aging
Epidemiology impact of agingEpidemiology impact of aging
Epidemiology impact of agingEusivia Pasi
 
Functional Capacity Evaluation
Functional Capacity EvaluationFunctional Capacity Evaluation
Functional Capacity EvaluationESS
 
Sudden Cardiac Death in Athletes
Sudden Cardiac Death in AthletesSudden Cardiac Death in Athletes
Sudden Cardiac Death in AthletesNimit Dalal
 
Physical Therapy Management of Patients with Diabetes
Physical Therapy Management of Patients with DiabetesPhysical Therapy Management of Patients with Diabetes
Physical Therapy Management of Patients with DiabetesKyle Veazey
 
Exercise Prescription For Diabetes
Exercise Prescription For DiabetesExercise Prescription For Diabetes
Exercise Prescription For Diabetesrobstennis
 
Exercise prescription in diabetes mellitus
Exercise prescription in diabetes mellitusExercise prescription in diabetes mellitus
Exercise prescription in diabetes mellitusDr Amrit Parihar
 

What's hot (20)

Physical activity in people with disabilities and elderly people
Physical activity in people with disabilities and elderly peoplePhysical activity in people with disabilities and elderly people
Physical activity in people with disabilities and elderly people
 
Geriatric pt
Geriatric ptGeriatric pt
Geriatric pt
 
Pt in geriatric
Pt in geriatric  Pt in geriatric
Pt in geriatric
 
exercise prescription
exercise prescriptionexercise prescription
exercise prescription
 
Physiotherapy assessment of cardiac conditions
Physiotherapy assessment of cardiac conditionsPhysiotherapy assessment of cardiac conditions
Physiotherapy assessment of cardiac conditions
 
Exercise for special populations
Exercise for special populationsExercise for special populations
Exercise for special populations
 
Diabetes Mellitus and Physical Therapy
Diabetes Mellitus and Physical Therapy Diabetes Mellitus and Physical Therapy
Diabetes Mellitus and Physical Therapy
 
Exercise Physiology In Pediatrics
Exercise Physiology In PediatricsExercise Physiology In Pediatrics
Exercise Physiology In Pediatrics
 
Epidemiology impact of aging
Epidemiology impact of agingEpidemiology impact of aging
Epidemiology impact of aging
 
Geriatric rehab
Geriatric rehabGeriatric rehab
Geriatric rehab
 
Functional Capacity Evaluation
Functional Capacity EvaluationFunctional Capacity Evaluation
Functional Capacity Evaluation
 
Sudden Cardiac Death in Athletes
Sudden Cardiac Death in AthletesSudden Cardiac Death in Athletes
Sudden Cardiac Death in Athletes
 
PRE PARTICIPATION EXAMINATION I Dr.RAJAT JANGIR JAIPUR
PRE PARTICIPATION EXAMINATION  I Dr.RAJAT JANGIR JAIPURPRE PARTICIPATION EXAMINATION  I Dr.RAJAT JANGIR JAIPUR
PRE PARTICIPATION EXAMINATION I Dr.RAJAT JANGIR JAIPUR
 
Field Tests
Field TestsField Tests
Field Tests
 
Physical Therapy Management of Patients with Diabetes
Physical Therapy Management of Patients with DiabetesPhysical Therapy Management of Patients with Diabetes
Physical Therapy Management of Patients with Diabetes
 
Exercise Prescription For Diabetes
Exercise Prescription For DiabetesExercise Prescription For Diabetes
Exercise Prescription For Diabetes
 
1. Effect of exercise on Body systems
1. Effect of exercise on Body systems1. Effect of exercise on Body systems
1. Effect of exercise on Body systems
 
Exercise prescription in diabetes mellitus
Exercise prescription in diabetes mellitusExercise prescription in diabetes mellitus
Exercise prescription in diabetes mellitus
 
Geriatric Exercise Prescription
Geriatric Exercise PrescriptionGeriatric Exercise Prescription
Geriatric Exercise Prescription
 
Deconditioning
DeconditioningDeconditioning
Deconditioning
 

Viewers also liked

Prescribing Exercise For Older Adults Art As Much As Science
Prescribing Exercise For Older Adults   Art As Much As SciencePrescribing Exercise For Older Adults   Art As Much As Science
Prescribing Exercise For Older Adults Art As Much As Sciencewelldoc
 
Balance Training Toolbox for Older Adults
Balance Training Toolbox for Older AdultsBalance Training Toolbox for Older Adults
Balance Training Toolbox for Older AdultsSue Scott
 
Functional Fitness Solutions for Older Adults: How to Assess and Interpret Po...
Functional Fitness Solutions for Older Adults: How to Assess and Interpret Po...Functional Fitness Solutions for Older Adults: How to Assess and Interpret Po...
Functional Fitness Solutions for Older Adults: How to Assess and Interpret Po...Debra Atkinson Voice For Fitness
 
Exercise dr. hudson
Exercise  dr. hudsonExercise  dr. hudson
Exercise dr. hudsonhfrazier
 
Balance Training in Athletes and Elderly (Rehabilitation)
Balance Training in Athletes and Elderly (Rehabilitation)Balance Training in Athletes and Elderly (Rehabilitation)
Balance Training in Athletes and Elderly (Rehabilitation)Prochnost
 
Cognitive Benefits of Exercise for Seniors
Cognitive Benefits of Exercise for SeniorsCognitive Benefits of Exercise for Seniors
Cognitive Benefits of Exercise for SeniorsMark Dreher PhD
 
About Respecting Our Elders
About Respecting Our EldersAbout Respecting Our Elders
About Respecting Our EldersRuth Schwartz
 
The Use of Resistance Training in the Prevention and Treatment of Osteoporosi...
The Use of Resistance Training in the Prevention and Treatment of Osteoporosi...The Use of Resistance Training in the Prevention and Treatment of Osteoporosi...
The Use of Resistance Training in the Prevention and Treatment of Osteoporosi...alicia_jade
 
Thera band instruction manual
Thera band instruction manualThera band instruction manual
Thera band instruction manualcuitino
 
Physical Education During Dark Ages
Physical Education During Dark AgesPhysical Education During Dark Ages
Physical Education During Dark AgesNecel Jala
 
The Open, Social Web Workshop
The Open, Social Web WorkshopThe Open, Social Web Workshop
The Open, Social Web WorkshopChris Messina
 
Health Promotion and Disease Prevention under the Aquino Health Agenda by Use...
Health Promotion and Disease Prevention under the Aquino Health Agenda by Use...Health Promotion and Disease Prevention under the Aquino Health Agenda by Use...
Health Promotion and Disease Prevention under the Aquino Health Agenda by Use...HealthJustice Philippines
 

Viewers also liked (16)

Aging powerpoint
Aging powerpointAging powerpoint
Aging powerpoint
 
Prescribing Exercise For Older Adults Art As Much As Science
Prescribing Exercise For Older Adults   Art As Much As SciencePrescribing Exercise For Older Adults   Art As Much As Science
Prescribing Exercise For Older Adults Art As Much As Science
 
Balance Training Toolbox for Older Adults
Balance Training Toolbox for Older AdultsBalance Training Toolbox for Older Adults
Balance Training Toolbox for Older Adults
 
Functional Fitness Solutions for Older Adults: How to Assess and Interpret Po...
Functional Fitness Solutions for Older Adults: How to Assess and Interpret Po...Functional Fitness Solutions for Older Adults: How to Assess and Interpret Po...
Functional Fitness Solutions for Older Adults: How to Assess and Interpret Po...
 
Exercise dr. hudson
Exercise  dr. hudsonExercise  dr. hudson
Exercise dr. hudson
 
Balance Training in Athletes and Elderly (Rehabilitation)
Balance Training in Athletes and Elderly (Rehabilitation)Balance Training in Athletes and Elderly (Rehabilitation)
Balance Training in Athletes and Elderly (Rehabilitation)
 
Balance Training
Balance TrainingBalance Training
Balance Training
 
Cognitive Benefits of Exercise for Seniors
Cognitive Benefits of Exercise for SeniorsCognitive Benefits of Exercise for Seniors
Cognitive Benefits of Exercise for Seniors
 
Functional training
Functional trainingFunctional training
Functional training
 
About Respecting Our Elders
About Respecting Our EldersAbout Respecting Our Elders
About Respecting Our Elders
 
The Use of Resistance Training in the Prevention and Treatment of Osteoporosi...
The Use of Resistance Training in the Prevention and Treatment of Osteoporosi...The Use of Resistance Training in the Prevention and Treatment of Osteoporosi...
The Use of Resistance Training in the Prevention and Treatment of Osteoporosi...
 
Thera band instruction manual
Thera band instruction manualThera band instruction manual
Thera band instruction manual
 
Physical Education During Dark Ages
Physical Education During Dark AgesPhysical Education During Dark Ages
Physical Education During Dark Ages
 
The Open, Social Web Workshop
The Open, Social Web WorkshopThe Open, Social Web Workshop
The Open, Social Web Workshop
 
Health Promotion and Disease Prevention under the Aquino Health Agenda by Use...
Health Promotion and Disease Prevention under the Aquino Health Agenda by Use...Health Promotion and Disease Prevention under the Aquino Health Agenda by Use...
Health Promotion and Disease Prevention under the Aquino Health Agenda by Use...
 
Healthy Aging PowerPoint
Healthy Aging PowerPointHealthy Aging PowerPoint
Healthy Aging PowerPoint
 

Similar to Exercise in Older Adults

update on sudden cardiac death in athletes and young generation
update on sudden cardiac death in athletes and young generationupdate on sudden cardiac death in athletes and young generation
update on sudden cardiac death in athletes and young generationTamer Taha
 
3. muscular strength and cardiovascular disease
3. muscular strength and cardiovascular disease3. muscular strength and cardiovascular disease
3. muscular strength and cardiovascular diseasefarzana khantoon
 
2. exercise prescription for patients with acute coronary syndrome
2. exercise prescription for patients with acute coronary syndrome2. exercise prescription for patients with acute coronary syndrome
2. exercise prescription for patients with acute coronary syndromeHibaAnis2
 
2. Special consideration in cardiac rehabilitation program for older adults.
2. Special consideration in cardiac rehabilitation program for older adults.2. Special consideration in cardiac rehabilitation program for older adults.
2. Special consideration in cardiac rehabilitation program for older adults.ShagufaAmber
 
Sports cardiology talk slideshare export
Sports cardiology talk slideshare exportSports cardiology talk slideshare export
Sports cardiology talk slideshare exportJohn Vyselaar
 
The Elderly With Heart Disease internship project
The Elderly With Heart Disease internship projectThe Elderly With Heart Disease internship project
The Elderly With Heart Disease internship projectjinyeob kim
 
Myths and legacy of exercisemedicine in chronic diseases
Myths and legacy of exercisemedicine in chronic diseasesMyths and legacy of exercisemedicine in chronic diseases
Myths and legacy of exercisemedicine in chronic diseasesAnn Gates
 
The role of exercise in medicine
The role of exercise in medicineThe role of exercise in medicine
The role of exercise in medicineNursing Hi Nursing
 
Saiha alina, 17bpt030, cad(pt cardio)
Saiha alina, 17bpt030, cad(pt cardio)Saiha alina, 17bpt030, cad(pt cardio)
Saiha alina, 17bpt030, cad(pt cardio)BPT4thyearJamiaMilli
 
Exercise prescription for health and fitness.pptx
Exercise prescription for health and fitness.pptxExercise prescription for health and fitness.pptx
Exercise prescription for health and fitness.pptxAvaniAkbari
 
Coronary Heart Disease and Exercise: What's the evidence?
Coronary Heart Disease and Exercise: What's the evidence?Coronary Heart Disease and Exercise: What's the evidence?
Coronary Heart Disease and Exercise: What's the evidence?Yeong Yeh Lee
 
Special population presentations day 3
Special population presentations day 3Special population presentations day 3
Special population presentations day 3Leesah Mapa
 
Competitive sports in cvs diseases
Competitive sports in cvs diseasesCompetitive sports in cvs diseases
Competitive sports in cvs diseasesRohitWalse2
 
Seminar presentation 8
Seminar presentation 8Seminar presentation 8
Seminar presentation 8SumaiyaShams
 
Gynaecological problems in female sports person
Gynaecological problems in female sports personGynaecological problems in female sports person
Gynaecological problems in female sports personAntima Rathore
 
Seminar presentation 30 sept 2020
Seminar presentation 30 sept 2020Seminar presentation 30 sept 2020
Seminar presentation 30 sept 2020SumaiyaShams
 

Similar to Exercise in Older Adults (20)

update on sudden cardiac death in athletes and young generation
update on sudden cardiac death in athletes and young generationupdate on sudden cardiac death in athletes and young generation
update on sudden cardiac death in athletes and young generation
 
3. muscular strength and cardiovascular disease
3. muscular strength and cardiovascular disease3. muscular strength and cardiovascular disease
3. muscular strength and cardiovascular disease
 
2. exercise prescription for patients with acute coronary syndrome
2. exercise prescription for patients with acute coronary syndrome2. exercise prescription for patients with acute coronary syndrome
2. exercise prescription for patients with acute coronary syndrome
 
2. Special consideration in cardiac rehabilitation program for older adults.
2. Special consideration in cardiac rehabilitation program for older adults.2. Special consideration in cardiac rehabilitation program for older adults.
2. Special consideration in cardiac rehabilitation program for older adults.
 
Sports cardiology talk slideshare export
Sports cardiology talk slideshare exportSports cardiology talk slideshare export
Sports cardiology talk slideshare export
 
The Elderly With Heart Disease internship project
The Elderly With Heart Disease internship projectThe Elderly With Heart Disease internship project
The Elderly With Heart Disease internship project
 
Cardiac rehabitalization ppt
Cardiac rehabitalization pptCardiac rehabitalization ppt
Cardiac rehabitalization ppt
 
Myths and legacy of exercisemedicine in chronic diseases
Myths and legacy of exercisemedicine in chronic diseasesMyths and legacy of exercisemedicine in chronic diseases
Myths and legacy of exercisemedicine in chronic diseases
 
The role of exercise in medicine
The role of exercise in medicineThe role of exercise in medicine
The role of exercise in medicine
 
Saiha alina, 17bpt030, cad(pt cardio)
Saiha alina, 17bpt030, cad(pt cardio)Saiha alina, 17bpt030, cad(pt cardio)
Saiha alina, 17bpt030, cad(pt cardio)
 
Exercise prescription for health and fitness.pptx
Exercise prescription for health and fitness.pptxExercise prescription for health and fitness.pptx
Exercise prescription for health and fitness.pptx
 
Coronary Heart Disease and Exercise: What's the evidence?
Coronary Heart Disease and Exercise: What's the evidence?Coronary Heart Disease and Exercise: What's the evidence?
Coronary Heart Disease and Exercise: What's the evidence?
 
Cardiac screening high school athletes
Cardiac screening high school athletesCardiac screening high school athletes
Cardiac screening high school athletes
 
Erectile Dysfunction
Erectile DysfunctionErectile Dysfunction
Erectile Dysfunction
 
Special population presentations day 3
Special population presentations day 3Special population presentations day 3
Special population presentations day 3
 
Exercise ecg
Exercise ecgExercise ecg
Exercise ecg
 
Competitive sports in cvs diseases
Competitive sports in cvs diseasesCompetitive sports in cvs diseases
Competitive sports in cvs diseases
 
Seminar presentation 8
Seminar presentation 8Seminar presentation 8
Seminar presentation 8
 
Gynaecological problems in female sports person
Gynaecological problems in female sports personGynaecological problems in female sports person
Gynaecological problems in female sports person
 
Seminar presentation 30 sept 2020
Seminar presentation 30 sept 2020Seminar presentation 30 sept 2020
Seminar presentation 30 sept 2020
 

Recently uploaded

SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdfHongBiThi1
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyMedicoseAcademics
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptxNIKITA BHUTE
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfDolisha Warbi
 

Recently uploaded (20)

SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before Pregnancy
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
 
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
 

Exercise in Older Adults

  • 2. Dr Jason Kaplan June 2013 Exercise in Older Adults
  • 3. The benefits of middle age fitness • Arch Int Med 2012 University of Texas • Age 49 EST / 5 categories /1970– Most to least ( majority ) Cooper Clinic • RV records from 1999-2009 • Adults least fit at Middle age checkup most likely to develop chronic disease at earlier age heart diabetes, cancer
  • 4. • Most fit – some still developed but later in life – ie lived with chronic disease later in life for shorter time periods • “ lenghthening of Morbidity “ • “ The Fit live well ! “
  • 5. Invasion of the MAMILS !
  • 9. METS Activity METS Slow walk 2-3 Golf 3-5 Fast walk / tennis doubles 4-5 Hiking 6-7 Dancing, rowing 6-7 Bicycle, swimming 6-10 Singles Tennis 7-12 Running 10 km /hr 10 Running 15 km/hr 16 MET- 3.5 mL O2 uptake /kg/min = resting oxygen uptake in sitting position
  • 10. Myers J et al. N Engl J Med 2002;346:793-801 Relative Risks of Death from Any Cause among Subjects with Various Risk Factors Who Achieved an Exercise Capacity of Less Than 5 MET or 5 to 8 MET, as Compared with Subjects Whose Exercise Capacity Was More Than 8 METS
  • 11. Myers J et al. N Engl J Med 2002;346:793-801 Age-Adjusted Relative Risks of Death from Any Cause According to Quintile of Exercise Capacity among Normal Subjects and Subjects with Cardiovascular Disease
  • 13. CAD in older athletes • Routine physical exercise is associated with reduced morbidity and mortality from CAD, but vigorous physical exertion also transiently increases the risk of both acute myocardial infarction (MI) and SCD. • In most cases, the risk to asymptomatic individuals without prior atherosclerotic disease is small.
  • 14. CAD older athletes • athletes with established CAD remain at some increased risk for SCD or MI, and any CAD risk factors should be vigorously treated. • Regular physical exercise improves an individual’s CV risk profile and reduces CVD morbidity and mortality. • vigorous exercise also increases the short- term risk of coronary events and sudden death by 5- to 7-fold compared to rest.
  • 15. Who Needs An EST prior to vigorous Exercise • The American College of Cardiology and American Heart Association recommend exercise treadmill testing for asymptomatic patients with diabetes mellitus, men older than 45 years of age, and women older than 55 years of age before they undertake vigorous exercise, with the decision to incorporate myocardial imaging based on the baseline ECG and pre-test probability of CAD • Level of evidence B
  • 16. 2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults • 1. An exercise ECG may be considered for cardiovascular risk assessment in intermediate-risk asymptomatic adults (including sedentary adults considering starting a vigorous exercise program), par- ticularly when attention is paid to non-ECG markers such as exercise capacity.
  • 17. The EST – Key points • - doesn’t predict SCD or MI ( CACS better ) – rupture non stenotic plaque • Useful in risk after event/ revasc ie BP/ He, rythym • HR and BP response important • Exercise not hand grip • Exercise duration predicts survival • Talk test vs age regression ( 220 – age X 70- 80%)
  • 18. Watch these People • Uncontrolled SBP > 160 at rest ( BP will to rise with exercise ) • Active Symptoms( CP, SOB, Palp, Syncope) • Strong Family History – those over age 50 • Poorly controlled lipids • Any exercise induced symptom is significant
  • 19. Cardiovascular risk stratification for exercise • AHA ( prob outdated ) • Class A- healthy,no clinical evidence of inc CVS Risk • Class B - established CHD- LOW RISK • Class C- mod/high risk/ previous events • Class D- contraindicated • MET- 3.5 mL O2 uptake /kg/min = resting oxygen uptake in sitting position.
  • 21. Class A • Lets talk about it !
  • 25. Older Athletes • Masters Athletes • Age varies by sport – Generally over 40 years of age • Organized sports that require systematic training for competition • General use – synonym for “older athlete”
  • 26. • Masters Athletes – Aging Well • Declines in athletic performance inevitable with aging • Peak endurance performance maintained to age 35 • Modest decreases to age 50-60 Progressively steeper declines > age 60 • Tanaka H, Seals DR. Endurance exercise performance in Masters athletes. J Physiol. 2008 Jan 1;586(1):55-63.
  • 27. • Masters Athletes – Aging Well • 3 main physiological determinants of reduction – Lactate threshold reduced – Exercise economy stable – Maximal oxygen consumption • Decreases in maximal stroke volume, heart rate, & AV O2 difference • Reduced intensity & volume in training sessions
  • 28. • Prolonged Endurance Exercise • 25 healthy 51-59 yo volunteers (21 males) from 2010 & 11 Manitoba Marathons • Assessed Cardiac biomarkers & TTE assessed 1 wk prior to, immediately after & 1 wk after the marathon – CMR was performed at baseline & within 24 hrs of marathon completion CCT within 3 months of marathon – Karlstedt E, et al. The impact of repeated marathon running on cardiovascular function in the aging population. J Cardiovasc Magn Reson. 2012;14(1):58.
  • 29. • Prolonged Endurance Exercise – All participants demonstrated an elevated cTnT, RA & RV volumes post marathon – RV systolic function decreased significantly immediately post marathon • Returned to baseline 1 week later – Marathon associated with transient, reversible increase in cardiac biomarkers & RV systolic dysfunction
  • 30. • Long Term Marathon Running • 26 women ≥ 10 annual marathons (n=26) – Less coronary plaque prevalence (19 vs. 50%) – Less calcific plaque volume (43 vs. 77 mm3) • 50 men ≥ 25 annual marathons (n=50) – Similar plaque prevalence – Increased total plaque volume (200 vs. 126 mm3, – p<0.01), calcified plaque volume (84 vs. 44 mm3, p<0.0001), & non-calcified plaque volume (116 vs. 82, p=0.04) • All significantly lower resting HR, body mass, BMI, & TG levels & higher HDL cholesterol levels
  • 31. • Long Term Marathon Running – Compared to a control population • Men running marathons for longer time – Paradoxically increased coronary plaque volume & prevalence – Women had lower coronary artery plaque prevalence & less calcified plaque volume • Schwartz RS, et al. Coronary Artery Plaque in Long Term Marathon Runners Assessed by High Resolution CCTa. (unpublished data)
  • 32. Why Inc Risks • Arterial stiffness ( PWA- Sphygmacor) higher in marathon runners • Atrial remodelling and atrial arrhythmias • Increased pro- inflammatory markers – Il 6 , TNF, Chromagraffin A, CRP • Marathon Study • Statins also seem to increase risks muscle related injury
  • 33. Older age/ Endurance Key Points • Marathon running is associated with a small increased incidence of SCD, which is dependent on age, sex, and training status. (The risk from a half-marathon is significantly less.) • Myocardial hypertrophy and coronary ischemia are the fundamental pathophysiologic entities, with the former more likely to be fatal.
  • 34. • Despite a significantly more favorable CV risk profile in marathon runners, coronary calcification and myocardial injury are relatively common and seen more frequently than in a control population of non-runners.
  • 35. Take HOME POINTS CAD older athletes • It is important to know how important exercise is to the individual patient: “Some people are hooked on it and it is very important to their lives.” • we know their risk of coronary events increases during intense activity. It’s not possible to precisely determine this increased risk, but it is greater than at rest.
  • 36. • “Treat risk factors aggresively especially their lipids.” Hopefully, intensive lipid-lowering will stabilize their plaques and permit them to continue their chosen activity. • Warning: some patients think that because they are in good shape and run marathons, they do not have to take cholesterol-lowering therapy. You are most likely to see this in people with risk factors who want to ignore them.
  • 37. Message from British Heart Foundation