This document discusses how lung capacity, heart capacity, and other cardiovascular functions naturally decline with age. It summarizes studies showing that high-intensity interval training can help reverse these declines and improve health outcomes. The document then introduces PACE (Progressively Accelerating Cardiopulmonary Exertion) as a high-intensity interval training method that starts at a level appropriate for each individual and gradually increases in intensity over time. Examples are given of PACE improving body composition, cardiovascular risk factors, and pulmonary function for some individuals. The document concludes by describing a current study examining the effects of a PACE-style exercise program.

1. Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD

2. A video is worth a thousand
slides…
Add video of Dr Sears on top of K2

3. Let’s look at what the “experts” are
recommending:
• American Medical Association
• Moderate intensity exercise for 30-minutes/day, at least 5
days/week
• American College of Sports Medicine
• Moderate intensity exercise for 30-minutes/day, at least 5
days/week
• American Heart Association
• Moderate intensity exercise for 30-minutes/day, at least 5
days/week
• National Institute of Health
• “regular, moderate exercise”

4. What if Everything You
Thought You Knew About
Exercise Was Wrong?

5. The “Big 3” Cause More
Problems Than They Solve
1. Aerobics
2. Cardio
3. Weight training
These modern approaches to exercise don’t
work.

6. The Advice from the “Experts”
Take You Down the Wrong Path
Modern Exercise Advice won’t help you:
1) Build functional strength
2) Make your heart stronger
3) Improve lung capacity

7. INTENSITY VS. DURATION
• 8,896 recreational runners reported average exercise
duration and intensity
• High-intensity exercise associated with:
Lower blood pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower waist, hip, and chest circumferences
• Exercise duration had no effect on these parameters
Williams P. Relationships of heart disease risk factors to exercise quantity and intensity. Arch Intern Med. 1998;158(3):237-245.

8. HARVARD ALUMNI HEALTH
STUDIES
• 17,321 male alumni followed for 20 years
• High-intensity exercise was associated with a significant
decrease in all-cause mortality
• No relationship between low-intensity exercise and death
Lee IM, Hsieh, CC, Paffenparger, RS Jr. Exercise intensity and longevity in men. The Harvard Alumni Health Study. JAMA.
1995;273(15):1179-1184
.

9. Exercise Intensity and Mortality
Harvard Health Study
RelativeRiskofDeath(%)
Exercise Intensity
Lee IM, Hsieh, CC, Paffenparger, RS Jr. Exercise intensity and longevity in men. The Harvard Alumni Health Study. JAMA.
1995;273(15):1179-1184

10. The Data are Clear...
Prestigious studies like the
Framingham Heart Study and the
Harvard Health Study have
demonstrated that exercise intensity –
not duration – is predictive of health
and longevity

11. Are Your Lungs Dying?
Age
MeanVitalCapacity(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.

12. FEV1 Declines With Age
Age
FEV1(liters)
Adapted from: Dean, W. Biological Aging Measurement. 1988

13. VO2Max Declines With Age
20
24
28
32
36
40
44
48
52
10 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79
Males
Females
VO2max(ml/kg/min)
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005

14. Even Moderate Pulmonary Impairment Increases
Risk of Death
Years Post Follow-Up
FEV (%)
Quintile:
RelativeRiskofDeath(allcauses)
Schunemann H, et al. Pulmonary function is a long-term predictor of mortality in the general population: 29-year follow-up of the Buffalo Health
Study. Chest. 2000 Sep;118(3):656-64.

15. 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

16. Incidence of Congestive Heart Failure
According to Vital Capacity
RateofCHF/1000
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.

17. The Bottom Line
• Lung capacity decreases with age
• Decreased lung capacity  increased risk of all-
cause mortality and 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.
Kannel WB, Seidman JM, Fercho W, Castelli WP. Vital Capacity and Congestive Heart Failure. The Framingham Study.
Circulation. 1974;49(6):1160-1166.

18. Some Good News...
It’s possible to reverse the age-related
loss of pulmonary function … if you
focus on exercise intensity

19. Pre- and Post-Intervention
Pulmonary Function
VO2peak(L/min)
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.

20. Building Younger Lungs
MaxO2Uptake(ml/Kgmin)
Age
Adapted from: von Ardennne, M. Oxygen Multistep Therapy. Theime. 1990. p.31.

21. But what is happening to our
heart capacity?

22. Maximum HR Declines With Age
140
145
150
155
160
165
170
175
180
185
190
30 35 40 45 50 55 60 65 70 75
Adapted from: Dean, W. Biological Aging Measurement. 1988
MaxHR(BPM)
Age

23. Cardiac Output Declines With Age
3.5
4
4.5
5
5.5
6
6.5
7
20 - 30 30 - 40 40 - 50 50 - 60 60 - 70 70 - 80 80 - 90
CardiacOutput(L/min)
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.

24. Some More Good News...
It’s possible to reverse the age-related
loss of cardiac function … if you focus
on exercise intensity

25. High-Intensity Exercise Improves
Cardiac Function – Study Design
Patients with
prior MI
(n = 29)
Control/no
training
(n = 8)
Low-intensity
training*
(n = 11)
High-intensity
training**
(n = 10)
*Low-intensity: HR @ 80% of gas exchange threshold (GET)
**High-intensity: (HR @ GET – HR @ peak exercise)(40%) + HR @ GET
Adachi H, Koike A, Obayashi T, et al. Does appropriate endurance exercise training improve cardiac function in patients with
prior myocardial infarction? Eur Heart J. 1996 Oct;17(10):1511-21.

26. High-Intensity Exercise Improves
Peak O2 Uptake During Exercise
Adachi H, Koike A, Obayashi T, et al. Does appropriate endurance exercise training improve cardiac function in patients with
prior myocardial infarction? Eur Heart J. 1996 Oct;17(10):1511-21.

27. High-Intensity Exercise Improves
Ejection Fraction During Exercise
Changeinejectionfraction(%)
*
P = 0.024
Adachi H, Koike A, Obayashi T, et al. Does appropriate endurance exercise training improve cardiac function in patients with
prior myocardial infarction? Eur Heart J. 1996 Oct;17(10):1511-21.

28. Low-Intensity Exercise Reduces
Cardiac Function
6-months 12-months
∆ResttoPeakLVEF(%)
Oberman, A, Fletcher F, Lee J, et al. Efficacy of high-intensity exercise training on left ventricular ejection fraction in men with coronary artery disease (the
Training Level Comparison Study). Am J Cardiol. 1995 Oct 1;76(10):643-7.

29. The Faustian Bargain of Fitness
To keep up with popular trends, you will increase
cardiac endurance but lose the one thing that
will save you from a heart attack:
Cardiac Capacity

30. Do Humans Really Need Endurance
Training?
Ancient man never had the need for long-duration,
medium-intensity exertion. This is also true in
the animal kingdom.
Short bursts of high-intensity are the norm for both
man and animals. This kind of exertion is
natural for survival, i.e. – escaping from
predators, hunting, climbing

31. Your Heart Doesn’t Need Endurance
Training
The heart was designed by nature to last a lifetime. It
doesn’t need training to pump blood for 80 or even 90
years.
If you train for endurance, you only increase efficiency in
the narrow range of medium-intensity output.

32. Endurance Training is a High-
Risk Challenge
This kind of activity forces your body to make dangerous
choices, via adaptive responses:
•Regulation of body temperature
•Metabolism of waste products
•Conservation of energy – forces the storage of energy to maintain
supply for repeated duration challenges. This usually occurs as
the production and storage of body fat.

33. Sacrificing Your Ability to Survive a
Deadly Heart Attack
• The energy you need to fuel endurance training
wipes out your heart’s reserve capacity
• In a weakened state, your heart has no reserve
energy to supply a sudden demand for more oxygen
• During times of stress, this inability to rapidly supply
more oxygen results in a heart attack

34. Cardiac Reserve and Heart Failure
Maximal level
CardiacPowerOutput*(w)
* Cardiac Power Output = (cardiac output)(arterial pressure)
Adapted from: Williams S, Barker D, Goldspink D, Tan L. A reappraisal of concepts in heart failure: central role of cardiac power reserve. Arch Med Sci
2005; 1(2) 65-74

35. These Data Support the Need to
Reclaim Native Fitness
High-intensity exertion – the kind practiced by our
ancient ancestors – is the key to modern
cardiopulmonary health

36. Exercise Intensity and Metabolism
What Does Your Body Use for Fuel?
ACTIVITY LEVEL PROTEIN CARBS FAT
Resting 1 to 5% 35% 60%
Low intensity 5 – 8% 70% 15%
Moderate Intensity 2 to 5% 40% 55%
High Intensity 2% 95% 3%
Adapted from: McArdle W et al. Sports & Exercise Nutrition. New York, NY: Lippincott, Williams & Wilkins;1999

37. The German Secret to Olympic Gold
• Interval training was the first formalized style of high-
intensity exertion used to train athletes in the 1930’s
• However...interval training is demanding and not
suited for people who are deconditioned and/or
grossly overweight

38. The Solution
P.A.C.E
PROGRESSIVELY
ACCELERATING
CARDIOPULMONARY
EXERTION

39. The One Think Modern Exercise
Lacks: Progressivity
• Regular and consistent increases in the intensity of demands placed on the
cardiovascular system by making repeated changes in the same direction
• Analogous to inflating a balloon: the best way to fill a balloon to capacity is
by gradually adding more air during each inflation
• Similar to muscle hypertrophy training where muscle capacity is increased
by progressively adding small amounts of additional weight
• KEY POINT: In PACE, high-intensity is a relative term. This means that
each individual will work towards their own unique level of maximum
exertion. This makes PACE the safest form of exercise

40. Improving Your Response Time:
Acceleration
• Training to increase the speed at which the heart and lungs respond
to increases in demand
• Recovery back to resting heart rate/respiration also happens more
quickly
• KEY POINT: most cardiac arrests occur when the heart is unable to
respond to a sudden and dramatic increase in demand. Training for
acceleration helps the heart to respond quickly to potentially life-
threatening demands – reducing the risk of sudden cardiac death

41. 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

42. PACE Twin Study – Body Fat Loss
0
2
4
6
8
10
12
14
16
18
4 8 12 16
Traditional Cardio
PACE
PoundsofFatLost
Weeks Post-Training

43. PACE Twin Study –
Change in Lean Body Mass
-2
0
2
4
6
8
10
4 8 12 16
Traditional Cardio
PACE
Weeks Post-Training
ChangeinLeanBodyMass(lbs)

44. PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL

45. T.L. – Body Fat (%)
20
25
30
35
40
45
50
55
1 2 3 4 5 6 7 8 9 10 11 12 13 14
BodyFat(%)
Months Post-Training

46. T.L. – Triglycerides
Triglycerides(mg/dL)

47. T.L. – HDL
HDL(mg/dL)

48. PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions

49. M.P. – Body Fat (%)
0
5
10
15
20
25
30
35
40
45
Initial 2 12 14
Months post-training
BodyFat(%)

50. M.P. – Increase in Lean Body Mass
0
5
10
15
20
25
30
35
2 12 14
Months post-training
ChangeinLeanBodyMass(lbs)

51. 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

52. What Makes a PACE Workout?
• Running
• Rowing
• Swimming
• Bicycling
• Jumping rope
• Calisthenics
• Stair stepping
• Elliptical
• Circuit training
• Hindu squats
• Kettle bells

53. PACE is Safe, Effective and Non-
Threatening
• Interval training requires high-performance and aggressive goals,
which may not be realistic for the average person.
• In contrast, PACE is progressively challenging. This allows the
individual to set goals based on their current level of conditioning.
Over time, high-intensity exertion becomes possible
• PACE is not psychologically or emotionally threatening. Because
you start at a level that is comfortable, even if all you can do is walk,
the idea of exertion and exercise is non-threatening

54. PACE Trial
My Wellness Research Foundation is
currently conducting a longitudinal study to
examine the efficacy of the PACE program

55. 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