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Copyright © 2006 Lippincott Williams & Wilkins.
Exercise, Successful Aging, and Disease
Prevention
Exercise, Successful Aging, and Disease
Prevention Chapter 17Chapter 17
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ObjectivesObjectives• Describe what the term “healthspan” means• Explain the concept of successful aging
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)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)Objectives (cont’d)
• List the three major causes of death in the 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)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 AmericaThe 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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Copyright © 2006 Lippincott Williams & Wilkins.
Copyright © 2006 Lippincott Williams & Wilkins.
Copyright © 2006 Lippincott Williams & Wilkins.
Copyright © 2006 Lippincott Williams & Wilkins.
Successful AgingSuccessful 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 AgingPhysical 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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HealthspanHealthspan
• The total number of years a person remains in excellent health
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Healthy Life ExpectancyHealthy 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)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)
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
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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Copyright © 2006 Lippincott Williams & Wilkins.
Healthy People 2010Healthy 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 DeathExercise 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)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)
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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Copyright © 2006 Lippincott Williams & Wilkins.
Aging and Muscular Strength
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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SarcopeniaSarcopenia
• Refers to a decrease in muscle mass associated with aging
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Muscle Trainability Among the Elderly
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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Copyright © 2006 Lippincott Williams & Wilkins.
Aging and Joint FlexibilityAging 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
Aging and Endocrine Changes
• Endocrine function changes with age, particularly the pituitary, pancreas, adrenal, and thyroid glands
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Impaired Glucose Metabolism
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
Aging and Thyroid Dysfunction
• Thyroid dysfunction commonly occurs in the elderly as a result of:– Lowered pituitary gland secretion of
thyroid-stimulating hormone– Reduced output of thyroxine by the
thyroid gland
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Copyright © 2006 Lippincott Williams & Wilkins.
Aging and the Hypothalamic-Pituitary-
Gonadal Axis
Aging and the Hypothalamic-Pituitary-
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 CortexAdrenal 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 AxisGrowth 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 insulin-like growth factor (IGF) 1 also occurs
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Aging and Nervous System Function
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 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
Aging and Cardiovascular Function
• Maximal oxygen uptake ( O2max) declines 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 offset aging’s effect on O2max
V
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Copyright © 2006 Lippincott Williams & Wilkins.
Aging and Cardiovascular Function (cont’d)
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 for the decrease in O2max per kg of active muscle that accompanies aging
V
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Copyright © 2006 Lippincott Williams & Wilkins.
Aging Response to Exercise Training
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 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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Copyright © 2006 Lippincott Williams & Wilkins.
Copyright © 2006 Lippincott Williams & Wilkins.
Copyright © 2006 Lippincott Williams & Wilkins.
Benefits of Regular ExerciseBenefits of Regular Exercise
• Regular physical activity and exercise attenuates the risks associated with:– Smoking– Obesity– Diabetes– Hypertension– Coronary heart disease
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Copyright © 2006 Lippincott Williams & Wilkins.
Copyright © 2006 Lippincott Williams & Wilkins.
Copyright © 2006 Lippincott Williams & Wilkins.
Coronary Heart Disease (CHD)
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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Copyright © 2006 Lippincott Williams & Wilkins.
Gender Differences and CHD
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)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 PectorisAngina Pectoris
• Chest pain due to an inadequate myocardial perfusion
• Usually emerges during periods of exertion, which increases myocardial oxygen demand
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Copyright © 2006 Lippincott Williams & Wilkins.
Modifiable CHD Risk FactorsModifiable CHD Risk Factors
• Cigarette smoking• Hypercholesterolemia• Diabetes mellitus• Hypertension
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Cigarette Smoking and CHDCigarette 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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Copyright © 2006 Lippincott Williams & Wilkins.
Lifestyle and LipoproteinsLifestyle 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)
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)
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 CHDHypertension 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 CHDDiabetes 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 FactorsOther CHD Risk Factors
• 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.