Download Exercise, Successful Aging, and Disease Prevention

Exercise, Successful Aging,
and Disease Prevention
Chapter 17
Copyright © 2006 Lippincott Williams & Wilkins.
Objectives
• Describe what the term “healthspan” means
• Explain the concept of successful aging
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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?
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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
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Objectives (cont’d)
• List the three major causes of death in the
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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
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Objectives (cont’d)
• 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
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The 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
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Successful Aging
• Requires maintenance of enhanced:
– Physiologic function
– Physical fitness
• Components of successful aging
– Physical health
– Spirituality
– Emotional and educational health
– Social satisfaction
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Physical Activity and Aging
• Physical activity attenuates the impact that
“normal aging” has on:
– Blood pressure
– Body composition
– Insulin sensitivity
– Bone mass
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Healthspan
• The total number of years a person
remains in excellent health
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Healthy 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
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Copyright © 2006 Lippincott Williams & Wilkins.
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
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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
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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
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Healthy People 2010
• Primary aims
– Increase quality and years of healthy life
– Eliminate health disparities among the
nation’s citizens
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Exercise 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
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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
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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
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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%
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Sarcopenia
• Refers to a decrease in muscle mass
associated with aging
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Muscle Trainability Among the
Elderly
• Regular exercise training retains body
protein and blunts the loss of muscle mass
and strength with aging
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Aging 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%
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Aging and Endocrine Changes
• Endocrine function changes with age,
particularly the pituitary, pancreas,
adrenal, and thyroid glands
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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
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Aging and Thyroid Dysfunction
• Thyroid dysfunction commonly occurs in
the elderly as a result of:
– Lowered pituitary gland secretion of thyroidstimulating hormone
– Reduced output of thyroxine by the thyroid
gland
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Aging and the HypothalamicPituitary-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
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Adrenal 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
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Growth 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 insulinlike growth factor (IGF) 1 also occurs
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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
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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
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Aging and Cardiovascular
Function
 O2max) declines
• Maximal oxygen uptake (V
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
 O2max
offset aging’s effect on V
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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
O
for the decrease in V
2max per kg of active
muscle that accompanies aging
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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
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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
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Benefits of Regular Exercise
• Regular physical activity and exercise
attenuates the risks associated with:
– Smoking
– Obesity
– Diabetes
– Hypertension
– Coronary heart disease
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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
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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
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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
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Angina Pectoris
• Chest pain due to an inadequate
myocardial perfusion
• Usually emerges during periods of
exertion, which increases myocardial
oxygen demand
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Modifiable CHD Risk Factors
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Cigarette smoking
Hypercholesterolemia
Diabetes mellitus
Hypertension
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Cigarette Smoking and CHD
• Both active and passive smoking increase
CHD risk
• Smokers experience twice the risk of
death from CHD compared to nonsmokers
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Lifestyle 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
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Lifestyle and Lipoproteins
(cont’d)
• Factors favorably affecting cholesterol and
lipoprotein levels include:
– Increased dietary intake of omega-2 fatty
acids
– Moderate alcohol consumption
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Lifestyle and Lipoproteins
(cont’d)
• 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
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Hypertension 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
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Diabetes 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
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Other CHD Risk Factors
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Age
Gender
Heredity
Immunologic
factors
• Homocysteine
• Excessive body fat
• Physical inactivity
• C-reactive protein
• Lipoprotein(a)
[Lp(a)]
• Fibrinogen
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Copyright © 2006 Lippincott Williams & Wilkins.