physiological aging process &role of exercise dr_r.heidari moghadam (md&phd) exercise...
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Physiological aging Physiological aging process &role of process &role of
exerciseexercise
Dr_R.heidari Dr_R.heidari moghadammoghadam (MD&PhD) (MD&PhD)
Exercise physiologistExercise physiologist
DEFINITION OF AGINGDEFINITION OF AGING
Old and aging depends on the age Old and aging depends on the age and experience of the speaker.and experience of the speaker.
Chronological age - number of Chronological age - number of years livedyears lived
Physiologic age - age by body Physiologic age - age by body functionfunction
Functional age - ability to Functional age - ability to contribute to societycontribute to society
CHRONOLOGICAL CHRONOLOGICAL CATEGORIESCATEGORIES
Young-Old - (ages 65 - 74)Young-Old - (ages 65 - 74)
Middle-Old - (ages 75 - 84)Middle-Old - (ages 75 - 84)
Old-Old - (age 85 and olderOld-Old - (age 85 and older))
PHYSIOLOGICAL PHYSIOLOGICAL THEORIES OF THEORIES OF
AGINGAGING
What causes the body to What causes the body to age?age?
PROGRAM THEORYPROGRAM THEORY
CellsCells replicate a specific replicate a specific number of times and then number of times and then die. Happens again, and die. Happens again, and again in lab experiments.again in lab experiments.
ERROR THEORYERROR THEORY
The structure of DNA The structure of DNA is altered as people is altered as people ageage
Due to alterations, Due to alterations, DNA not read correctlyDNA not read correctly
Results in Results in transcription and transcription and translation translation malfunctionmalfunction
Results in Results in aging/illness/ cancer aging/illness/ cancer directly, or indirectlydirectly, or indirectly
CELLULAR THEORYCELLULAR THEORY
Normal wear and tear Normal wear and tear causes cells to function causes cells to function
improperlyimproperly
FREE RADICAL THEORYFREE RADICAL THEORY
Lipids in cell Lipids in cell membranes are membranes are exposed to exposed to radiation or free radiation or free radicalsradicals
Cell membrane Cell membrane ruptures ruptures and cell and cell diesdies
In test tubes this In test tubes this actually occursactually occurs
NUTRITIONAL MODEL NUTRITIONAL MODEL THEORYTHEORY
If animal fed 50-If animal fed 50-60% less than it 60% less than it eats on its own - eats on its own - lives longerlives longer
Assumption: Lean Assumption: Lean mass, as opposed mass, as opposed to adipose tissue to adipose tissue results in greater results in greater healthhealth
COLLAGEN THEORY OF AGINGCOLLAGEN THEORY OF AGING
As we age, As we age, collagencollagen in in body ages also. Causesbody ages also. Causes hypertension hypertension and other and other
organ malfunctionsorgan malfunctions
MUTATING AUTO-IMMUNE MUTATING AUTO-IMMUNE THEORYTHEORY
Cells have normal functions - Cells have normal functions - secrete normal proteinssecrete normal proteins
As cells age - mutate and As cells age - mutate and secretions viewed as foreign by secretions viewed as foreign by bodybody
Solicits immune responseSolicits immune response Shuts cell downShuts cell down Cause biological errors and entire Cause biological errors and entire
organ malfunctionsorgan malfunctions
NEURO-AGING THEORYNEURO-AGING THEORY
All cells undergo All cells undergo nervous system nervous system degenerationdegeneration
Results in Results in changes in changes in hormonal releasehormonal release
Leads to decline Leads to decline in cell functionin cell function
NONE OF THESE NONE OF THESE THEORIES THEORIES TOTALLY TOTALLY
ACCEPTEDACCEPTEDScientists hypothesize it Scientists hypothesize it might be combination of might be combination of
several or allseveral or all
RESPIRATORY RESPIRATORY SYSTEMSYSTEM
Lungs become more Lungs become more rigidrigid
Pulmonary function Pulmonary function decreasesdecreases
Number and size of Number and size of alveoli decreasesalveoli decreases
Vital capacity declinesVital capacity declines Reduction in Reduction in
respiratory fluidrespiratory fluid Bony changes in chest Bony changes in chest
cavitycavity
CARDIOVASCULAR CARDIOVASCULAR SYSTEMSYSTEM
Heart smaller and less Heart smaller and less elastic with ageelastic with age
By age 70 cardiac output By age 70 cardiac output reduced 70%reduced 70%
Heart valves become Heart valves become scleroticsclerotic
Heart muscle more Heart muscle more irritableirritable
More arrhythmiasMore arrhythmias Arteries more rigidArteries more rigid Veins dilateVeins dilate
REPRODUCTIVE SYSTEMREPRODUCTIVE SYSTEM
Male:Male: Reduced testosterone levelReduced testosterone level Testes atrophy and softenTestes atrophy and soften Decrease in sperm Decrease in sperm
productionproduction Seminal fluid decreases Seminal fluid decreases
and more viscousand more viscous Erections take more timeErections take more time Refractory period after Refractory period after
ejaculation may lengthen ejaculation may lengthen to daysto days
REPRODUCTIVE SYSTEMREPRODUCTIVE SYSTEM
Female:Female: Declining estrogen and Declining estrogen and
progesterone levelsprogesterone levels Ovulation ceasesOvulation ceases Introitus constricts Introitus constricts
and loses elasticityand loses elasticity Vagina atrophies - Vagina atrophies -
shorter and driershorter and drier Uterus shrinksUterus shrinks Breasts pendulous and Breasts pendulous and
lose elasticitylose elasticity
NEUROLOGICAL SYSTEMNEUROLOGICAL SYSTEM
Neurons of central and Neurons of central and peripheral nervous system peripheral nervous system degeneratedegenerate
Nerve transmission slowsNerve transmission slows Hypothalamus less effective in Hypothalamus less effective in
regulating body temperatureregulating body temperature Reduced REM sleep, decreased Reduced REM sleep, decreased
deep sleepdeep sleep After 50% lose 1% of neurons After 50% lose 1% of neurons
each yeareach year
MUSCULOSCELETAL MUSCULOSCELETAL SYSTEMSYSTEM
Adipose tissue increases with Adipose tissue increases with ageage
Lean body mass decreasesLean body mass decreases Bone mineral content Bone mineral content
diminisheddiminished Decrease in height from Decrease in height from
narrow vertebral spacesnarrow vertebral spaces Less resilient connective Less resilient connective
tissuetissue Synovial fluid more viscousSynovial fluid more viscous May have exaggerated May have exaggerated
curvature of spinecurvature of spine
GoalsGoals
Develop an understanding of normal Develop an understanding of normal aging physiologyaging physiology
Incorporate aerobic and resistance Incorporate aerobic and resistance exercise into treatment and exercise into treatment and prevention plans of the elderlyprevention plans of the elderly
Appropriate pre-exercise assessmentAppropriate pre-exercise assessment
Physiologic changes with Physiologic changes with aging (Board Questions)aging (Board Questions)
Decreased Decreased Muscle massMuscle mass Muscle strengthMuscle strength Muscle powerMuscle power Muscle enduranceMuscle endurance Muscle contraction Muscle contraction
velocityvelocity Muscle Muscle
mitochondrial mitochondrial functionfunction
Muscle oxidative Muscle oxidative enzyme capacityenzyme capacity
Physiologic changes with Physiologic changes with aging (Board Questions)aging (Board Questions)
DecreasedDecreased Maximal and Maximal and
submaximal aerobic submaximal aerobic capacitycapacity
Cardiac contractilityCardiac contractility Maximal heart rateMaximal heart rate Stroke volume and Stroke volume and
cardiac outputcardiac output Nerve conduction Nerve conduction
velocityvelocity BalanceBalance
DecreasedDecreased ProprioceptionProprioception Gait velocityGait velocity Gait stabilityGait stability Insulin sensitivityInsulin sensitivity Glucose toleranceGlucose tolerance Immune functionImmune function Bone Bone
mass/strength/densitymass/strength/density Collagen cross-linkage, Collagen cross-linkage,
thinning cartilage, thinning cartilage, tissue elasticitytissue elasticity
Physiologic QuestionsPhysiologic Questions
IncreasedIncreased Arterial stiffnessArterial stiffness Myocardial stiffnessMyocardial stiffness Systolic blood Systolic blood
pressurepressure Diastolic blood Diastolic blood
pressurepressure Visceral fat massVisceral fat mass Total body fatTotal body fat Intramuscular lipid Intramuscular lipid
accumulationaccumulation
Use It or Lose ItUse It or Lose It
Sedentary people lose large amounts of Sedentary people lose large amounts of muscle mass (20-40%)muscle mass (20-40%)
6% per decade loss of Lean Body Mass 6% per decade loss of Lean Body Mass (LBM)(LBM)
Aerobic activity not sufficient to stop this Aerobic activity not sufficient to stop this lossloss
Only resistance training can overcome this Only resistance training can overcome this loss of mass and strengthloss of mass and strength
Balance and flexibility training contributes Balance and flexibility training contributes to exercise capacityto exercise capacity
What is exercise?What is exercise?
Lifestyle choicesLifestyle choices Organized sportsOrganized sports Unstructured playUnstructured play Household and Household and
Occupational tasksOccupational tasks
Increased Muscle MassIncreased Muscle Mass Endurance training Endurance training
emphasisemphasis Walking isn’t enoughWalking isn’t enough
Progressive Progressive resistance trainingresistance training DM prevention?DM prevention? Dependency Dependency
prevention?prevention? Falls and fracturesFalls and fractures DisuseDisuse SarcopeniaSarcopenia FrailtyFrailty
Use It and Lose Less of ItUse It and Lose Less of It
Resistance training improves strength by a Resistance training improves strength by a range of range of
40-150%40-150% Lean body mass increases 1-3 kgLean body mass increases 1-3 kg Muscle fiber area 10-30%Muscle fiber area 10-30%
Body compositionBody composition
Genetic, lifestyle Genetic, lifestyle and disease factorsand disease factors
Metabolic, Metabolic, cardiovascular and cardiovascular and musculoskeletal musculoskeletal systems impactedsystems impacted
Lifestyle is under Lifestyle is under patient’s controlpatient’s control
Weight Weight manangementmanangement
Burning FatBurning Fat
Decreases in total body adipose Decreases in total body adipose tissuetissue Aerobic and resistive trainingAerobic and resistive training Energy restricted diets and/or high Energy restricted diets and/or high
volume exercise (5-7 hours/week)volume exercise (5-7 hours/week) Visceral fat selectively mobilizedVisceral fat selectively mobilized
What’s What’s fatfat got to do with got to do with it?it?
Metabolic syndromeMetabolic syndrome Vascular diseaseVascular disease OsteoarthritisOsteoarthritis Gallbladder diseaseGallbladder disease DiabetesDiabetes HypertensionHypertension DyslipidemiaDyslipidemia Sleep apneaSleep apnea
Breast cancerBreast cancer Colon cancerColon cancer Endometrial Endometrial
cancercancer ImpotenceImpotence OsteoarthritisOsteoarthritis DepressionDepression DisabilityDisability
Diabetes and Diabetes and OsteoporosisOsteoporosis
Insulin Resistance Insulin Resistance Improves insulin sensitivityImproves insulin sensitivity Detraining may reduce exercise effectDetraining may reduce exercise effect Primary prevention demonstratedPrimary prevention demonstrated
Osteoporosis prevention and treatmentOsteoporosis prevention and treatment Stabilization or increase in bone density in Stabilization or increase in bone density in
pre- and postmenopausal women with pre- and postmenopausal women with resistive or weight bearing exerciseresistive or weight bearing exercise
1-2% per year difference from controls1-2% per year difference from controls
DyslipidemiaDyslipidemia
Not a lot of data in elderlyNot a lot of data in elderly No clear primary and secondary prevention No clear primary and secondary prevention
datadata Exercise associated with less atherogenic Exercise associated with less atherogenic
profilesprofiles Duration and frequency factorsDuration and frequency factors Weight loss (or fat loss) associated with Weight loss (or fat loss) associated with
increased HDLincreased HDL Gender differences with trainingGender differences with training
Less training effect on HDL in womenLess training effect on HDL in women
HypertensionHypertension
Most trials cross sectional and cohortMost trials cross sectional and cohort Lower pressures in active individualsLower pressures in active individuals
5-10 mmHg5-10 mmHg Type and intensityType and intensity
Greater training effect in those with Greater training effect in those with mild to moderate hypertension mild to moderate hypertension 6-7 mmHg drop in systolic and diastolic 6-7 mmHg drop in systolic and diastolic
pressurepressure Effect present in low-to-moderate exerciseEffect present in low-to-moderate exercise
CVDCVD
Exercise training beneficial in CVDExercise training beneficial in CVD Reduced claudication painReduced claudication pain Greater walking distanceGreater walking distance Improved functional endpointsImproved functional endpoints
Benefit in selected patients with Benefit in selected patients with coronary artery diseasecoronary artery disease..
ArthritisArthritis
Improved functional statusImproved functional status Faster gaitFaster gait Lower depressionLower depression Less painLess pain Less medication useLess medication use Strength and endurance training Strength and endurance training
benefitbenefit
CancerCancer
Potential protective benefits with Potential protective benefits with Breast CancerBreast Cancer Colon CancerColon Cancer ProstatProstat
Exercise treatment of Exercise treatment of chronic diseasechronic disease
May treat symptoms and disuse and May treat symptoms and disuse and not the underlying diseasenot the underlying disease Parkinson’sParkinson’s COPDCOPD ClaudicationClaudication Chronic renal failureChronic renal failure
May reduce recurrence of diseaseMay reduce recurrence of disease CVDCVD FallsFalls
Emotional well beingEmotional well being
Genetic, social, Genetic, social, personality, and personality, and psychological psychological constructsconstructs
Leading cause of Leading cause of death and death and disability in disability in developed developed countriescountries
Exercise and Mental Exercise and Mental HealthHealth
Positive psychologic attributesPositive psychologic attributes Lower prevalence and incidence of Lower prevalence and incidence of
depressive symptomsdepressive symptoms Reversal of hippocampal volume loss?Reversal of hippocampal volume loss? Reversal of cognitive loss?Reversal of cognitive loss? 14 randomized, controlled trials:14 randomized, controlled trials:
Aerobic and resistance trainingAerobic and resistance training Higher intensitiesHigher intensities Meaningful improvements in depressionMeaningful improvements in depression Response rates of 31-88%Response rates of 31-88% Equipotent to standard treatmentEquipotent to standard treatment
Function relates to Function relates to strengthstrength
Non-linear relationship between strength Non-linear relationship between strength and functionand function Concept of ThresholdConcept of Threshold
EPESE Study:EPESE Study: Physically active patients at baseline less Physically active patients at baseline less
likely to develop disabilitylikely to develop disability Exercise improves functional limitationsExercise improves functional limitations
Functional balance tasksFunctional balance tasks Gait speedGait speed ArthritisArthritis
ContraindicationsContraindications
Relative Relative Acute illnessAcute illness Undiagnosed chest Undiagnosed chest
painpain Uncontrolled diabetesUncontrolled diabetes Uncontrolled Uncontrolled
hypertensionhypertension Uncontrolled asthmaUncontrolled asthma Uncontrolled CHFUncontrolled CHF Musculoskeletal Musculoskeletal
problemsproblems Weight loss and fallsWeight loss and falls
AbsoluteAbsolute Inoperable Aortic Inoperable Aortic
AneurysmAneurysm Cerebral aneurysmCerebral aneurysm Malignant Malignant
ventricular ventricular arrhythmiaarrhythmia
Critical aortic Critical aortic stenosisstenosis
End-stage CHFEnd-stage CHF Terminal illnessTerminal illness Behavioral problems Behavioral problems
Exercise PrescriptionExercise Prescription ModesModes
General activitiesGeneral activities AerobicAerobic
WalkingWalking SportsSports
ResistanceResistance Supervision/Supervision/
techniquetechnique Benefit with one setBenefit with one set
FlexibilityFlexibility Static stretchStatic stretch
BalanceBalance Risk assessmentRisk assessment Dynamic and static Dynamic and static
balancebalance
Mode governed by:Mode governed by: DurationDuration
30 minutes30 minutes FrequencyFrequency
Most daysMost days IntensityIntensity
Borg Scale 12-14Borg Scale 12-14 55-75% of MHR55-75% of MHR
MHRMHR
ACSM guidelines for ACSM guidelines for healthy aerobic activityhealthy aerobic activity
Exercise 3-5 days each weekExercise 3-5 days each week Warm up 5-10 minutes before aerobic Warm up 5-10 minutes before aerobic
activityactivity Maintain intensity for 30-45 minutesMaintain intensity for 30-45 minutes Gradually decrease intensity of Gradually decrease intensity of
workout, then stretch to workout, then stretch to cool down cool down during last 5-10 minutesduring last 5-10 minutes
If weight loss is goal, If weight loss is goal, 30 minutes 30 minutes five five days a weekdays a week
Aging and Aerobic Aging and Aerobic CapacityCapacity
Peak between 15-30Peak between 15-30 Declines with ageDeclines with age Approximately 10% per decade after Approximately 10% per decade after
age 25-30age 25-30 Masters Athletes: 5% per decadeMasters Athletes: 5% per decade Overall: 0.55 decline per year in VO2 Overall: 0.55 decline per year in VO2
maxmax Anaerobic threshold: occurs at lower Anaerobic threshold: occurs at lower
work rateswork rates
Benefits of Regular Physical Benefits of Regular Physical ActivityActivity
Cardiovascular healthCardiovascular health
Cholesterol, HDL, LDL, VO2,RHRCholesterol, HDL, LDL, VO2,RHR
Muscular healthMuscular health
Strengthens boneStrengthens bone
LBM enhanced/preservedLBM enhanced/preserved
BMR improved/maintainedBMR improved/maintained
Endurance/strength improvesEndurance/strength improves
More Benefits of Regular Physical Activity More Benefits of Regular Physical Activity
Reduces health risks associated with Reduces health risks associated with obesityobesity Enhances insulin actionEnhances insulin action Reduces body fatReduces body fat
Reduces cancers risk Reduces cancers risk Reduces susceptibility to infectionsReduces susceptibility to infections Improves peristaltic functionsImproves peristaltic functions Fewer injuriesFewer injuries Reduced health care costsReduced health care costs Psychological healthPsychological health
Stress and depressionStress and depression Improved QOLImproved QOL