What's Wrong with Cardio?

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What’s Wrong With Cardio? How to keep your heart from weakening, your lungs from shrinking, and your metabolism from dying. Dr. Al Sears

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How to keep your heart from weakening, your lungs from shrinking and your metabolism from dying.

Transcript of What's Wrong with Cardio?

Page 1: What's Wrong with Cardio?

What’s Wrong With Cardio?How to keep your heart from weakening,

your lungs from shrinking, and your metabolism from dying.

Dr. Al Sears

Page 2: What's Wrong with Cardio?

Traditional Cardiovascular Endurance Exercise (CVE)

• CVE (“cardio”) includes activities like aerobics classes and distance jogging.

• The recommendation is to keep HR between 70 – 80% of maximum for 30 – 60 minutes

Page 3: What's Wrong with Cardio?

Contrary to Popular Belief “Cardio” Fails to :

1. Preserve pulmonary function

2. Decrease risk of death from cardiovascular disease

3. Reduce overall mortality

4. Recondition metabolism for achieving and maintaining optimal body composition

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Pulmonary Function

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Vital Capacity Declines With Age

32 37 42 47 52 57 62 67 72 7715

20

25

30

35

40

45

Men

Women

Age

Mea

n Vi

tal C

apac

ity (d

L)

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.

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FEV1 Declines With Age

Age

FEV 1 (

liter

s)

Adapted from: Dean, W. Biological Aging Measurement. 1988

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VO2Max Declines With Age

10 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 7920

24

28

32

36

40

44

48

52

MalesFemales

VO2m

ax (m

l/kg/

min

)

Age

Wilmore J & Costill D. Physiology of Sport and Exercise:3 rd Edition. Campaign, IL: Human Kinetics. 2005

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So, what does this all mean?

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Pulmonary Function – The Most Important Consequence of Aging

• Framingham researchers followed 5209 participants over 18 years

• Biggest finding: the risk of congestive heart failure increased as lung capacity decreased

• 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

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Incidence of Congestive Heart Failure According to Vital Capacity

45 - 54 55 - 64 65 - 740

1

2

3

4

5

6

7

8

9

10

<4.5

4.5 - 5.1

5.2 - 5.7

>5.7

Rate

of C

HF/1

000

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.

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Even Moderate Pulmonary Impairment Increases Risk of Death

5 yr 10 yr0.5

1

1.5

2

2.5

5th4th3rd2nd1st

Years Post Follow-Up

FEV1 (%)Quintile:

Rel

ativ

e R

isk

of D

eath

(all

caus

es)

Cook DG, Shaper AG. Breathlessness, lung function and the risk of heart attack. Eur Heart J. 1988 Nov;9(11):1215-22.

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The Age-Related Decline in Pulmonary Function Can Be Reversed with the Right Physical Challenge

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Building Younger Lungs

5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 1000

10

20

30

40

50

60

People participating in high-intensity interval exercise

Non-exercising control group

Max

O2 U

ptak

e (m

l/Kg

min

)

Age

Adapted from: von Ardennne, M. Oxygen Multistep Therapy. Theime. 1990. p.31.

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Pre- and Post-Intervention Pulmonary Function

Low-Intensity Endurance Repeated All-Out Cycle Sprint

2.95

3

3.05

3.1

3.15

3.2

3.25

3.3

Pre-InterventionPost-Intervention

VO2p

eak (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.

Training Type

Page 15: What's Wrong with Cardio?

What We Know:

• There is an age-related decrease in pulmonary capacity

• Decreased pulmonary capacity → increased risk of heart failure

• Even moderate decreases in lung capacity → increase risk of death

• “Cardio” = does NOT reverse loss of pulmonary capacity

• High-intensity training = can completely reverse loss of pulmonary capacity.

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Cardiovascular Function

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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)

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.

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High-Intensity Exercise Improves Peak O2 Uptake During Exercise

Control Low-intensity High-intensity-10

40

90

140

190

240 P = 0.030

Chan

ge in

pea

k O

2 up

take

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.

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High-Intensity Exercise Improves Stroke Volume at Rest

Control Low-intensity High-intensity0

2

4

6

8

10

12

14

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.

Chan

ge in

stro

ke v

olum

e (m

l)

P = 0.014

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“Cardio” Reduces Change in Ejection Fraction

Series1

-0.6

-0.4

-0.2

1.11022302462516E-16

0.2

0.4

0.6

"Cardio"

High-intensity training

∆ Re

st to

Pea

k LV

EF (%

)

6-months 12-months

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.

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High-Intensity Exercise Improves Ejection Fraction During Exercise

Control Low-intensity High-intensity0

0.5

1

1.5

2

2.5

3

3.5 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.

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Why Does “Cardio” Fail to Deliver on its Promise?

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Endurance versus Capacity

• Endurance: the degree to which one can maintain exertion over a prolonged period of time. The extended duration of the activity requires a reduction in intensity.

• Capacity: the maximum intensity of exertion reached during an activity. The high intensity of the activity requires a reduction in duration.

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Consider Our Native Environment

• Natural selection favored capacity over endurance

• Selection pressures for high-capacity exertion were immediate and powerful

• Periods requiring low-intensity, longer-duration activity coincided with unfavorable conditions (war, famine, etc.). This resulted in adaptations that were functional at the time, but are dysfunctional in the modern environment.

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What’s Wrong With Endurance?

• The energy required for endurance comes at the expense of capacity, resulting in a decreased cardiac reserve

• Decreased cardiac reserve lowers energy expenditure during unfavorable conditions, but comes with a considerable cost if prolonged and repeated

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Cardiac Reserve and Heart Failure

Maximal level

Card

iac

Pow

er O

utpu

t* (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

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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

.

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Exercise Intensity and MortalityHarvard Health Study

Low Moderate High0.84

0.86

0.88

0.9

0.92

0.94

0.96

0.98

Exercise Intensity

Rela

tive

Risk

of D

eath

(%)

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

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Improvements in Other Age-Related Bio-markers

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High-Intensity Exertion Results in Improved Health Biomarkers

• 8896 recreation runners reported average exercise duration and intensity

• Relative to exercise duration, exercise intensity was associated with a:

13.3X greater reduction in systolic blood pressure

2.8X greater reduction in diastolic blood pressure

4.7X greater decrease in waist circumference

Williams P. Relationships of heart disease risk factors to exercise quantity and intensity. Arch Intern Med. 1998;158(3):237-245.

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High-Intensity Exertion, But Not “Cardio”, Increases Growth Hormone

"Cardio" High-Intensity Exertion0

1

2

3

4

5

6

7

8

Felsing NE, Brasel JA, Cooper DM. Effect of low and high intensity exercise on circulating growth hormone in men. J Clin Endocrinol Metab. 1992 Jul;75(1):157-62.

∆ in

gro

wth

hor

mon

e (m

icro

gram

s/L)

P < 0.05 relative to baseline

No significant change from baseline

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High-Intensity Exertion Raises Testosterone

Just 1-minute of high-intensity exertion raises testosterone by 38%

Gray AB, Telford RD, Weidemann MJ. Endocrine response to intense interval exercise. Eur J Appl Physiol Occup Physiol. 1993;66(4):366-71.

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High-Intensity Exertion Dramatically Improves Blood Flow

Blood Flow (ml/min)

Rest Light Exertion

Heavy Exertion

Maximal Exertion

Brain 750 880 1,000 1,400

Coronary Vessels

250 350 750 1,100

Lungs Basic Value (BV) 1.4 x BV 3 x BV 4 x BV

Skeletal Muscle

1,200 4,500 12,500 22,000

Cardiac Output

5,800 9,500 17,500 25,000

Page 34: What's Wrong with Cardio?

High-Intensity Exercise Preserves Telomere Length

15 25 35 45 55 655

6

7

8

9

10

VO2max (ml/kg/min)

Mea

n le

ukoc

yte

telo

mer

e le

ngth

(kb)

R = 0.44P < 0.01

LaRocca TJ, Seals DR, Pierce GL. Leukocyte telomere length is preserved with aging in endurance exercise-trained adults and related to maximal aerobic capacity. Mech Ageing Dev. 2010 Feb;131(2):165-7.

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Bottom Line: • High-intensity exertion reverses aging

• “Cardio” does NOT!

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But Doctor, what does this have to do with me?

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The SolutionP.A.C.E

PROGRESSIVELY

ACCELERATING

CARDIOPULMONARY

EXERTION

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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 hypertrophying skeletal muscle, training where muscle capacity is progressively increased by 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

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Acceleration • Training to increase the speed at which the heart and lungs respond to

increases in demand

• The same exertion level/target heart rate will be reached more quickly throughout the training process

• 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

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PACE -a New Exercise Principle

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“Cardio” Exercise Uses Fat as Fuel

• “Cardio” trains body to use fat as fuel, training body to store energy as fat.

• Fat becomes main energy storage – NOT muscle!!

Activity Protein Carbs Fat

“Cardio” 2 – 5% 40% 55%

High-intensity 2% 95% 3%

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PACE Exercise Uses Carbs as Fuel

By using carbs as fuel, PACE trains the body to store energy as ATP, creatine,

and glycogen – making muscle the main energy storage

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PACE Restores Youthful Energy

Energy stored in muscle allows for IMMEDIATE access to the energy, along with a greater willingness to expend it!!

Energy Storage

Energy Release

Maximum Power

Fat

Slow

Low

Muscle

Immediate

High

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The Real Magic of PACE HappensAFTER Exertion!!

• PACE ignites the body’s “after burner”

– During the 18-hours following high-intensity exertion, the body burns its fat stores in order to build more muscle!!

– High-intensity exertion results in a far greater loss of body fat compared to “cardio”

Tremblay A, Simoneau JA, Bouchard C. Impact of exercise intensity on body fatness and skeletal muscle metabolism. Metabolism. 1994 Jul;43(7):814-8.

Page 45: What's Wrong with Cardio?

High-Intensity Exertion Burns 9-Times More Fat Than “Cardio”

"Cardio" Hi-Intensity0

0.05

0.1

0.15

0.2

0.25

0.3

Chan

ge in

∑ o

f ski

n fo

lds /

ener

gy sp

ent

(mm

/MJ)

P<0.01

Tremblay A, Simoneau JA, Bouchard C. Impact of exercise intensity on body fatness and skeletal muscle metabolism. Metabolism. 1994 Jul;43(7):814-8.

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PACE – The Twin Study

PACE Twin• Decreased body fat

by14.5%• Gained 9-lbs lean muscle

“Cardio” Twin• Decreased body fat by 5%

• Lost 2-lbs lean muscle

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PACE Twin Study – Body Fat Loss

4 8 12 160

2

4

6

8

10

12

14

16

18

"Cardio"

PACEPoun

ds o

f Fat

Los

t

Weeks Post-Training

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PACE Twin Study – Change in Lean Body Mass

4 8 12 16

-2

0

2

4

6

8

10

"Cardio"

PACE

Weeks Post-Training

Chan

ge in

Lea

n Bo

dy M

ass (

lbs)

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Terri

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PACE Case Study – Terri

• 55 year-old female

• 250-lbs

• 50% body fat

• Elevated triglycerides

• Low HDL

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Terri – Body Fat (%)

1 2 3 4 5 6 7 8 9 10 11 12 13 1420

25

30

35

40

45

50

55

Body

Fat

(%)

Months Post-Training

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Terri - Triglycerides

Baseline 3-months 6-months170

190

210

230

250

270

Trig

lyce

rides

(mg/

dL)

Page 53: What's Wrong with Cardio?

Terri - HDL

Baseline 3-months 6-months40

42

44

46

48

50

52

54

56

58

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Richard -- Before

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Richard -- After

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Richard – Weight Loss

Series1200

220

240

260

280

300

320

340

Body

Wei

ght (

lbs)

Page 57: What's Wrong with Cardio?

Richard – Body Fat

40

5

10

15

20

25

30

35

40

45

Month

Body

Fat

(%)

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The Newest PACE Program – PACE Express

• A fully-guided 6-DVD fitness program, with all the principles of PACE built in to each 12-minute workout

• No specialized equipment required

• Uses Progressive Muscle Sequencing

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Progressive Muscle Sequencing

• Exercises rotate through all the large muscle groups

• This allows cardiopulmonary capacity to be reached prior to muscle failure

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Dijon – Lost 119 Pounds of Fat

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Elida -- Lost 27 Pounds of Fat

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Ana – Lost 10 Pounds of Fat

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Amanda – Lost 17 Pounds of Fat

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PACE Palm Beach StudyWeight Loss

1 2 3 4 5 6170

175

180

185

Month

Wei

ght (

lbs)

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PACE Palm Beach Study GroupBody Fat

1 2 3 4 5 623

24

25

26

27

28

29

30

31

32

33

Tota

l Bod

y Fa

t (%

)

Month

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PACE Palm Beach Study GroupSystolic Blood Pressure

1 2 3 4 5 6116

117

118

119

120

121

122

Month

Syst

olic

Blo

od P

ress

ure

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PACE Palm Beach Study GroupDiastolic Blood Pressure

1 2 3 4 5 673.5

73.7

73.9

74.1

74.3

74.5

74.7

74.9

75.1

75.3

75.5

Dias

tolic

Blo

od P

ress

ure

Month

Page 68: What's Wrong with Cardio?

PACE Los Angeles StudyWeight Loss

Initial 6-Day February June September160

165

170

175

180

185

190

Wei

ght (

lbs)

Month

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PACE Los Angeles StudyBody Fat

Initial February June September20

22

24

26

28

30

32

Month

Tota

l Bod

y Fa

t (%

)

Page 70: What's Wrong with Cardio?

PACE -- The Future

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PACE -- The Future

• New, state-of-the-art facility currently under construction in South Florida

• Will contain a full exercise physiology research lab for research – our first goal is to answer the questions regarding exactly how the body stores energy.

• Will also host community and professional seminars.

Page 72: What's Wrong with Cardio?

Certification Program

• The PACE Certification Program will allow health and fitness professionals to become PACE-Certified Trainers.

• Elements of the Certification Program will include:• The science of PACE• Components of PACE (breathing, rest/recovery, hydration)• How to tailor PACE to all fitness levels