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Physical Activity

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  1. 1. Physical activity and cardio-vascular prevention<br />Graziano Onder<br />Centro Medicina dell’Invecchiamento<br />Università Cattolica del Sacro Cuore<br />Rome - Italy<br />
  2. 2. Factors for successful aging <br />Male and female aging<br />Environmental factors<br />Metropolitan/rural area, personal environmental, injuries <br />Social factors<br />Education, social support, prevention, abuse<br />Economical factors<br />Type of work.<br />Personal factors<br />Biology, genetic factors<br />Successful aging <br />Social and Health services<br />Promotion of health, primary and secondary prevention, long-term care<br />Life style <br />Physical activity, nutrition, smoke, alcohol, drugs abuse <br />0NU 2002<br />
  3. 3. EXERCISE IN THE ELDERLY<br />THE ROLE OF EXERCISE IN THE ELDERLY<br />In the young-old, exercise has much the same function as in the young: <br /> - prevention of disease<br /> - maintenance of aerobic capacity <br /> - maintenance of muscle strength<br /> - psychological well-being<br />
  4. 4. b) In the old-old, exercise is still used for its preventive effects, but more often for: <br /> - secondary or tertiary prevention<br /> - rehabilitation from pre-existing<br /> chronic conditions<br />c) Some of the most important goals of exercise in the frail elderly are: <br /> - the improvement of muscle <br /> strength and endurance capacity to <br /> allow increased functional independence<br />
  5. 5.
  6. 6. Characteristics of study poplulation according to physical activity<br />
  7. 7. Risk of disability according to physical activity<br />
  8. 8. <ul><li> the prevention of falls and fall- related injuries</li></ul>- maintenance of fat-free mass<br /><ul><li> cardiovascular reconditioning, treatment of peripheral vascular
  9. 9. adjunctive treatment of depression, anxiety, isolation, insomnia, dementia- rehabilitation from neurologic diseases
  10. 10. increased survival</li></li></ul><li>
  11. 11. Crude and adjusted relative risk of mortality<br />Adjusted for gender and for all other possible risk factors for death (gender, physical and cognitive disability, cardiovascular diseases, pneumonia, cancer, stroke, diabetes, chronic obstructive pulmonary disease, renal failure, Parkinson’s disease, depression, delirium, and arthritis). <br />
  12. 12. Preventive Medicine 47 (2008) 422–426<br />
  13. 13. Crude and adjusted relative risks (RRs) of mortality in the Italian cohorts of the ilSIRENTE study, examined at baseline between 2003 and 2004 and after 24 months<br />Sedentary: subjects walking less than 1 h per day; Active: subjects walking 1 h or more per day.<br />Adjusted for age, gender and for other possible risk factors for death (functional and cognitive disability, congestive heart failure, hypertension, osteoarthritis, depression, number of medications, body mass index, cholesterol and C reactive protein).<br />
  14. 14. Incidence of Coronary Heart Disease<br />Honolulu HeartProgram<br />2678 activemen<br />Age: 71-93 years<br />FU: 2 to 4 years<br />Hakimet al. Circulation 1999<br />
  15. 15. Estimated rates of AMI<br />Men<br />Women<br />Men<br />Women<br />Mittleman et al. NEJM 1993<br />
  16. 16. Association between physical activity and stroke<br />Case controlstudy<br />1047 men and women<br />Age: 70 years<br />Sacco et al. Stroke 1998<br />
  17. 17. Mediators ?<br />
  18. 18. Physicalactivity - Lipids<br />Observationalstudy<br />380 men and women<br />Age: 68 years<br />FU: 10 years<br />% change<br />Petrellaet al. Diabetes Care 2005<br />
  19. 19. Physicalactivity – Body composition<br />173 women Age: 55-70 years<br />Irwinet al. JAMA 2003<br />
  20. 20. Physicalactivity – Diabetes<br />3234 non-diabeticAge: 50 years FU 2.8 years<br />Knowleret al. NEJM 2003<br />
  21. 21. Physicalactivity – Glucoseintolerance<br />424 menAge: 74 years FU 5 years<br />Van Dam et al. Med Sci SportsExerc 2002<br />
  22. 22. Physicalactivity and inflammation<br />Gaffkenet al. Am J Epidemiol. 2001 <br />
  23. 23. Physicalactivity – Hypertension<br />Wheltonet al. AnnInternMed 2002<br />
  24. 24. Mediators<br />Antiatherogeniceffects<br />Antithromboticeffects<br />↓plasma fibrinogen levels<br />↑ plasminogen activator<br />↑ active tissue plasminogen activator<br />↓ plasminogenactivatorinhibitor<br />Endothelialfunctionalteration<br />release of endothelium-derivedrelaxing (NO)<br />Fletcher et al. Circulation 2002<br />
  25. 25. Mediators<br />Autonomicfunctionalchanges<br />↑ parasympatheticactivity<br />Anti-ischemiceffects<br />↓ myocardial work (↓ BP and HR)<br />Antiarrhythmiceffects<br />improved myocardial oxygen supply-demand balance<br />↓ in sympathetic tone and catecholaminerelease<br />↑ ventricularfibrillation duringstrenuousexercise<br />Fletcher et al. Circulation 2002<br />
  26. 26. Whichtype of intervention?<br />Dynamicaerobic (endurance) exercise – running or walking<br />Dynamicresistanceanaerobic (strength) exercise – weight lifting <br />
  27. 27. Endurance<br />
  28. 28. Endurance<br />
  29. 29. Resistance<br />
  30. 30. Resistance<br />
  31. 31. Endurance training<br />Bloodpressure<br />Cardiac output<br />Vascularresistance<br />Stroke volume<br />Heart rate<br />Cornelissenet al. Hypertension 2005<br />
  32. 32. Resistance training<br />Cornelissenet al. J Hypert 2005<br />
  33. 33. Resistance and endurance training<br />Williams et al. Circulation 2007<br />
  34. 34. Resistance training<br />For persons at moderateto high risk of cardiac events, RT can be safely undertaken withproper preparation, guidance, and surveillance … given the extensive evidence of the benefits of aerobicexercise training on the modulation of cardiovascular risk factors,RT should be viewed as a complement to rather than a replacementfor aerobic exercise.<br />Williams et al. Circulation 2007<br />
  35. 35. Training - Guidelines<br />FrequencyIntensityDurationModality<br />Endurance training<br />3–5 days/week 50%–70% max HR 20–60 min Lower extremity: walking, jogging/running,stairclimber<br /> Upper extremity: arm ergometry<br />Combined: rowing, cross- country ski machines, combinedarm/leg cycling,<br />swimming, aerobics<br />Resistance training<br />2–3 days/week 1–3 sets of 8–15 RM Lower extremity: leg<br /> for each musclegroup extensions, leg curls, leg press, adductor/abductor<br /> Upper extremity: biceps curl, triceps extension, bench/overhead press. <br />Fletcher et al. Circulation 2002<br />
  36. 36. Age-AssociatedAlterations in PhysiologicalResponsetoAerobicExercise<br />Reduced aerobic capacity: decline in V˙ O2 max of 8% to 10% per decade in nontrainedpopulations<br />Reduced maximal heart rate of 1 beat/min per year<br />More rapid increase in systolic blood pressure with exercise<br />Attenuated rise in ejection fraction<br />Fletcher et al. Circulation 2002<br />
  37. 37. Classification of Physical Activity Intensity<br />MET=metabolic equivalents<br />1 MET = resting metabolic rate of 3.5 mL O2 * kg-1 * min-1<br />Fletcher et al. Circulation 2002<br />
  38. 38. Bottle<br />exercise<br />PHYSICAL ACTIVITY = MEDICINE <br />If exercise could be packed into a pill, it would be the single most widelyprescribed, and beneficial,medicine<br />Robert N. Butler, M.D. Director, National Institute on Aging<br />
  39. 39. Potential risks<br />General<br /><ul><li> Muscle soreness
  40. 40. Soft tissue injury
  41. 41. Falls
  42. 42. Fractures </li></ul>Resistance training <br /><ul><li> Detached retina
  43. 43. Hernia
  44. 44. Hemorrhage
  45. 45. Lumbar disk hernia </li></li></ul><li>Potential risks <br />Vigorous exercise<br /><ul><li> Sudden death
  46. 46. Acute myocardial infarction
  47. 47. Hypoglycemia in persons with diabetes
  48. 48. Orthostatic hypotension
  49. 49. Arrhythmia</li></li></ul><li> LIFE-P SPPB score<br />P<0.001<br />mo<br />mo<br />mo<br />Pahor et al J Gerontol A Biol Sci Med Sci 2006<br />
  50. 50. LIFE-P – Side effects<br />Pahor et al J Gerontol A Biol Sci Med Sci 2006<br />
  51. 51. Exercise in the Elderly- Screening<br /><ul><li> History
  52. 52. Physical
  53. 53. Cardiovascular reserve: get up and down from the examination table, walking 15 m, climbing 1 flight of stairs, cycling in the air for 1 min while lying down
  54. 54. ECG </li></ul>Gill et al JAMA 2000<br />
  55. 55. Exercise in the Elderly- Screening<br />It is not necessary that all individuals beginning a moderate-intensity and moderately progressive exercise program undergo an exercise stress test, although this issue remains controversial.<br />Gill et al JAMA 2000<br />
  56. 56. Exercise in the Elderly<br /><ul><li> Pre-exercise period of stretching and light activity involving the large muscle groups for 5-10 minutes
  57. 57. Extended cool-down period after physical activity
  58. 58. Importance of range of motion and flexibility exercises
  59. 59. Evaluation of participant’s footwear
  60. 60. Evaluation of thermoregulatory capacity of participant</li></ul>Gill et al JAMA 2000<br />
  61. 61. Majority of Americansdo not follow healthy lifestyle<br />2000 Behavioral Risk Factor Surveillance System, N = 153,805<br />100<br />77.8<br />76.7<br />80<br />59.9<br />60<br />Respondents<br />(%) <br />40<br />24.0<br />20<br />0<br />Smokers<br />BMI<br />≥25 kg/m2<br />Consumes<br />fruits/vegetables<br /><5x/day<br />Infrequentexercise(<5x/week)<br />Reeves et al. Arch Intern Med. 2005<br />
  62. 62. Conclusions<br />People of all ages, both male and female, benefit from regular physical activity<br /> Significant health benefits can be obtained by including a moderate amount of physical activity on most, if not all, days of the week<br />Additional health benefits can be gained through greater amounts of physical activity<br />
  63. 63. Conclusions<br />Physical activity reduces the risk of premature mortality in general, and of coronary heart disease, hypertension, stroke, and diabetes mellitus in particular <br />Bothaerobic (endurance) and resistence training mayinfluencehealthoutcomes<br />Potentialrisksrelatedtophysicalactivityshouldbealwaysconsidered<br />
  64. 64. Søren Kierkegaard in 1847 in a letter to his sister in law who had just been ill.<br />”Do not give up your wish to walk. I walk every day and feel well and walk away from any illness. I have had my best thoughts while walking and I do not know of any thoughts so dark that I can not walk away from them…”<br />