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Physical Activity, Exercise and Ageing
- 1. Physical Activity, Exercise and Ageing Professor Mike Trenell NIHR Senior Fellow E: michael.trenell@ncl.ac.uk W: www.MoveLab.org
- 3. FINISHED FILES ARE THE RE SULT OF YEARS OF SCIENTI FIC STUDY COMBINED WITH THE EXPERIENCE OF YEARS...
- 4. FINISHED FILES ARE THE RE SULT OF YEARS OF SCIENTI FIC STUDY COMBINED WITH THE EXPERIENCE OF YEARS...
- 5. FINISHED FILES ARE THE RE SULT OF YEARS OF SCIENTI FIC STUDY COMBINED WITH THE EXPERIENCE OF YEARS...
- 6. Using in translation…. Why think about ageing? A role for active lifestyles? Fit to Age?
- 7. Random Molecular Damage Accumulation of Cellular Defects Age-related frailty, disability and disease DNA damage (genome instability) Somatic mutations (copying errors, imperfect repair) Telomere shortening Chromosome rearrangements Mitochondrial-DNA mutations Gene disruption by viruses, transposons etc Aberrant epigenetic modifications RNA damage Transcription errors Aberrant splicing Protein damage Misfolding Synthesis errors Aberrant post-translational modifications Aberrant aggregation Impaired protein turnover (catabolism) Membrane damage Oxidation Kirkwood TBL. Nature 451, 664-667 (2008)
- 8. Life Accumulation of lifestyle changes Age-related frailty, disability and disease Cardio respiratory fitness Cognitive function Physical Activity Diet Muscle Mass Injuries Sleep Socioeconomic status Weather Exercise Ageing Strength Disease
- 9. United States Russia Holland Wide variation in Life Expectancy
- 10. Combined impact of four health behaviours on survival Epic Norfolk; free living healthy men and women 45-79 Healthy Ageing: Lifestyle Factors? Khaw et al. PLoS Med 2008 • Smoking • Fruit & Veg • Alcohol • Physical Activit
- 11. The challenge Adapted from: Barabási AL. N Engl J Med. 2007 26;357(4):404-7. Chronological Age Metabolic Deregulation Mitochondrial changes? Muscular dystrophyNAFLD T2 Diabetes Exercise Intolerance CVD
- 12. Summary We are living longer Longevity varies Lifestyle plays a key role
- 13. Using in translation…. Why think about ageing? A role for active lifestyles? Fit to Age?
- 15. Morris JN, et al. Lancet 265:1053–1057, 1953 Weller I, Epidemiology 9:632– 635, 1998 Manini TM, JAMA 296:171–179, 2006
- 16. Using in translation…. Why think about ageing? A role for active lifestyles? Fit to Age?
- 17. 0.25 0.5 0.75 1 Quintiles of maximal exercise capacity 1 2 3 4 5 Relativeriskofdeath Adjusted for age, sex, exam year, smoking status, ECG response, baseline health conditions As red but also % body fat <8.7 >18.4 8.7–11.2 11.3–13.6 13.7–18.3 Sui X, et al. JAMA 298: 2507-2516 (2007) Cardiovascular fitness and mortality: over 60yrs 2603 adults aged 60 years or older
- 18. CardiorespiratoryFitness (maxMETs) Men Women 5 10 15 8030 CardiorespiratoryFitness (%peak) 60 80 100 40 50 60 70 9020 8030 40 50 60 70 9020 Jackson, et al. Arch Intern Med 169, 1781–1787 (2009)
- 19. Jackson, et al. Arch Intern Med 169, 1781–1787 (2009) Women Cardiofitness (maxMETs) BMI 20; PAI 3 BMI 20; PAI 0 5 10 15 8030 40 50 60 70 9020 Men Cardiofitness (maxMETs) 5 10 15 BMI 30; PAI 3 BMI 30; PAI 0 Age years
- 20. Summary Being active is good Fitness is important
- 21. Using in translation…. Why think about ageing? A role for active lifestyles? Fit to Age?
- 22. Stroke Improving Quality of Life?
- 23. With Professor Mike Catt & Professor Patrick Olivier
- 24. 0 6 12 18 24 Time (h) Acceleration(g) -4-3-2-101234 Walking Standing Sitting Lying Other
- 25. With Professor Mike Catt & Professor Paul Watson
- 26. 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 healthy control baseline 3 months 6 months Daily steps * * Physical activity is low following stroke Moore, Hallsworth, Ford, Rochester, Trenell; PLoS One In Press 2013
- 27. -2 -1 0 1 2 3 4 5 6 7 Changeinpeakoxygen consumption(ml/kg/min) ** -20 0 20 40 60 80 100 120 140 Changein6MinuteWalkTest ** -20 -10 0 10 20 30 40 ChangeinOverallStroke RecoveryScore * -1 1 3 5 7 9 11 Changeincognitivescore * Moore, Hallsworth, He, Blamire, Ford, Rochester, Trenell; In Preparation 2013
- 28. Moore, Hallsworth, He, Blamire, Ford, Rochester, Trenell; In Preparation 2013
- 29. Older people and surgery An aid to decision making?
- 30. 0 5 10 15 20 25 <75y FIT <75y UNFIT >75y FIT >75y UNFIT Mortality(%) Snowdon, Prentis, Jones, Trenell. Annals of Surgery, Dec 2012 in press
- 31. Specificity Specificity Sensitivity Cardiorespiratry Fitness Age Snowdon, Prentis, Jones, Trenell. Annals of Surgery, Dec 2012 in press
- 32. 80 100 y(%)SurvivalProbability(%) 0 20 40 60 80 FIT UNFIT >75yrs FIT >75yrs UNFIT <75yrs FIT <75yrs UNFIT 0 20 40 60 80 100 0 20 40 60 80 100 SurvivalProbability(%) Total Hospital Length of Stay (Days) Critical Care Unit Length of Stay (Days) 0 0 10 20 30 >75yrs FIT >75yrs UNFIT <75yrs FIT <75yrs UNFIT Snowdon, Prentis, Jones, Trenell. Annals of Surgery, Dec 2012 in press
- 33. 0 20 40 60 80 100 0 20 40 60 80 100 SurvivalProbability(%) Total Hospital Length of Stay (Days) Critical Care Unit Length of Stay (Days) 0 0 10 20 30 >75yrs FIT >75yrs UNFIT <75yrs FIT <75yrs UNFIT Snowdon, Prentis, Jones, Trenell. Annals of Surgery, Dec 2012 in press
- 35. Meeting GPs and patients Focus groups and interviews
- 37. Engaging patients DVD lending library and task cards
- 38. Summary Mike Trenell www.MoveLab.org 8030 40 50 60 70 9020 Men Cardiofitness (maxMETs) 5 10 15 Age years 60 80 100 lProbability(%)SurvivalProbability(%) 0 20 40 60 80 FIT UNFIT >75yrs FIT >75yrs UNFIT <75yrs FIT <75yrs UNFIT
- 39. FINISHED FILES ARE THE RE SULT OF YEARS OF SCIENTI FIC STUDY COMBINED WITH THE EXPERIENCE OF YEARS...
- 40. Summary Mike Trenell www.MoveLab.org 8030 40 50 60 70 9020 Men Cardiofitness (maxMETs) 5 10 15 Age years 60 80 100 lProbability(%)SurvivalProbability(%) 0 20 40 60 80 FIT UNFIT >75yrs FIT >75yrs UNFIT <75yrs FIT <75yrs UNFIT
Editor's Notes
- Describe what driver and conductor do.Pass through last two panels quickly. Reiterate – this is not exercise – this is everyday life (what you are doing now).
- Data in white in maximal METS achieved during a progressive exercise test
- Research has demonstrated that physical activity and cardiorespiratory fitness levels are low following stroke. Indeed I demonstrated in a cross sectional longitudinal study conducted as part of my PhD that total energy expenditure, physical activity and step counts are significantly reduced in the week following stroke and although levels were found to increase by three months post stroke by six months they had plateaued before reaching levels comparable to healthy controls and conducive to health. So how much physical activity are individuals undertaking at present following stroke? This is a study we carried out recently investigating energy expenditure and PA in 31 individuals following stroke in the North East. At baseline participants were expending less than 1840 calories per day almost 400 calories less than an age sex and BMI matched control group and were only taking just over 3000 steps per day in comparison to 8000 in healthy controls. PA plateau’d at 3 and six months step count only half that of governemtn recommendation 10,000 steps per day and MET level just above resting metabolic rate. Average length of stay 2 days for those who were on ward for whole 7 day monitoring period average under 1000 steps per day MET level basic metabolic rate1) To define energy expenditure and physical activity levels at baseline in individuals following stroke in comparison to an age, sex and BMI matched control group. 2) To establish whether physical activity and energy expenditure levels change over time following stroke.Inclusion; diagnosis stroke within 2 weeks, >50 yrs, mild/mod gait deficit, exclusion severe cognitive/speech probs mobility probs other than stroke, medical history.n=31 average age 73, BMI 27, NIHSS 2 (range 0-7), MRS (0-3) Barthel (60-100)Healthy 2200 vs. baseline 1840 baseline, 3 months 2100, 6 months 2093 nearly 400 calories less PA equivalent to 2 mars barsPAEE 79, baseline 28, 63 3 months, 66 6 monthsDaily steps healthy 7996, baseline 3111, 3 months 5763, 6 months 5927MET 1.3, baseline, 1.0 3 months 1.15, 6 months 1.16.
- I went on to see if increasing energy expenditure and physical activity via a structured community based exercise programme would primarily improve metabolic risk factors associated with stroke risk such as dyslipidaemia and hypertension and secondarily what effect exercise would have on brain physiology, physical function, cognition and well being. The results of my randomised trial indicated that structured exercise is well tolerated with minimal risks and leads to improvements in self report of overall stroke recovery, cognition, cardiorespiratory fitness and walking speed and endurance. We also for the first time demonstrated using state of the art MRI techniques that exercise may be a way to reduce stroke and age related atrophy in the hippocampus.
- I went on to see if increasing energy expenditure and physical activity via a structured community based exercise programme would primarily improve metabolic risk factors associated with stroke risk such as dyslipidaemia and hypertension and secondarily what effect exercise would have on brain physiology, physical function, cognition and well being. The results of my randomised trial indicated that structured exercise is well tolerated with minimal risks and leads to improvements in self report of overall stroke recovery, cognition, cardiorespiratory fitness and walking speed and endurance. We also for the first time demonstrated using state of the art MRI techniques that exercise may be a way to reduce stroke and age related atrophy in the hippocampus.
- Data in white in maximal METS achieved during a progressive exercise test
- There are 111,000 first strokes in the UK every year and stroke is the leading cause of disability in the UK and most countries worldwide. Unfortunately stroke is not an isolated event and if you have had one stroke your chances of having another are 30-40%. Due to the high incidence of stroke and the need for long term rehabilitation and nursing care stroke care has been estimated to cost the UK up to 2.5 billion per year and these costs are liekly to rise with an exepcted increase in stroke related burden in the next two decades. As most patients with stroke survive the initial illness the greatest health effect is usually the long term consequences for patients and their families. Despite the fact stroke is such a big problem there is a lack of high quality evidence on the most effective forms of stroke rehabilitation and in particular there is a lack of clear guidance on lifestyle interventions post stroke and their possible health benefits.