Physiological aging process &role of exercise Dr_R.heidari moghadam (MD&PhD) Exercise physiologist

DEFINITION OF AGING Old and aging depends on the age and experience of the speaker. Old and aging depends on the age and experience of the speaker. Chronological age - number of years lived Chronological age - number of years lived Physiologic age - age by body function Physiologic age - age by body function Functional age - ability to contribute to society Functional age - ability to contribute to society

CHRONOLOGICAL CATEGORIES Young-Old - (ages ) Young-Old - (ages ) Middle-Old - (ages ) Middle-Old - (ages ) Old-Old - (age 85 and older) Old-Old - (age 85 and older)

PHYSIOLOGICAL THEORIES OF AGING What causes the body to age?

PROGRAM THEORY Cells replicate a specific number of times and then die. Happens again, and again in lab experiments.

ERROR THEORY The structure of DNA is altered as people age Due to alterations, DNA not read correctly Results in transcription and translation malfunction Results in aging/illness/ cancer directly, or indirectly

CELLULAR THEORY Normal wear and tear causes cells to function improperly

FREE RADICAL THEORY Lipids in cell membranes are exposed to radiation or free radicals Cell membrane ruptures and cell dies In test tubes this actually occurs

NUTRITIONAL MODEL THEORY If animal fed 50-60% less than it eats on its own - lives longer Assumption: Lean mass, as opposed to adipose tissue results in greater health

COLLAGEN THEORY OF AGING As we age, collagen in body ages also. Causes hypertension and other organ malfunctions

MUTATING AUTO-IMMUNE THEORY Cells have normal functions - secrete normal proteins Cells have normal functions - secrete normal proteins As cells age - mutate and secretions viewed as foreign by body As cells age - mutate and secretions viewed as foreign by body Solicits immune response Solicits immune response Shuts cell down Shuts cell down Cause biological errors and entire organ malfunctions Cause biological errors and entire organ malfunctions

NEURO-AGING THEORY All cells undergo nervous system degeneration Results in changes in hormonal release Leads to decline in cell function

NONE OF THESE THEORIES TOTALLY ACCEPTED Scientists hypothesize it might be combination of several or all

PHYSIOLOGICAL AGING OF THE HUMAN BODY BY SYSTEMS

RESPIRATORY SYSTEM Lungs become more rigid Pulmonary function decreases Number and size of alveoli decreases Vital capacity declines Reduction in respiratory fluid Bony changes in chest cavity

CARDIOVASCULAR SYSTEM Heart smaller and less elastic with age By age 70 cardiac output reduced 70% Heart valves become sclerotic Heart muscle more irritable More arrhythmias Arteries more rigid Veins dilate

REPRODUCTIVE SYSTEM Male: Reduced testosterone level Testes atrophy and soften Decrease in sperm production Seminal fluid decreases and more viscous Erections take more time Refractory period after ejaculation may lengthen to days

REPRODUCTIVE SYSTEM Female: Declining estrogen and progesterone levels Ovulation ceases Introitus constricts and loses elasticity Vagina atrophies - shorter and drier Uterus shrinks Breasts pendulous and lose elasticity

NEUROLOGICAL SYSTEM Neurons of central and peripheral nervous system degenerate Neurons of central and peripheral nervous system degenerate Nerve transmission slows Nerve transmission slows Hypothalamus less effective in regulating body temperature Hypothalamus less effective in regulating body temperature Reduced REM sleep, decreased deep sleep Reduced REM sleep, decreased deep sleep After 50% lose 1% of neurons each year After 50% lose 1% of neurons each year

MUSCULOSCELETAL SYSTEM Adipose tissue increases with age Adipose tissue increases with age Lean body mass decreases Lean body mass decreases Bone mineral content diminished Bone mineral content diminished Decrease in height from narrow vertebral spaces Decrease in height from narrow vertebral spaces Less resilient connective tissue Less resilient connective tissue Synovial fluid more viscous Synovial fluid more viscous May have exaggerated curvature of spine May have exaggerated curvature of spine

Exercise and Aging

Goals Develop an understanding of normal aging physiology Develop an understanding of normal aging physiology Incorporate aerobic and resistance exercise into treatment and prevention plans of the elderly Incorporate aerobic and resistance exercise into treatment and prevention plans of the elderly Appropriate pre-exercise assessment Appropriate pre-exercise assessment

Exercise and aging physiology

Physiologic changes with aging (Board Questions) Decreased Decreased Muscle mass Muscle mass Muscle strength Muscle strength Muscle power Muscle power Muscle endurance Muscle endurance Muscle contraction velocity Muscle contraction velocity Muscle mitochondrial function Muscle mitochondrial function Muscle oxidative enzyme capacity Muscle oxidative enzyme capacity

Physiologic changes with aging (Board Questions) Decreased Decreased Maximal and submaximal aerobic capacity Maximal and submaximal aerobic capacity Cardiac contractility Cardiac contractility Maximal heart rate Maximal heart rate Stroke volume and cardiac output Stroke volume and cardiac output Nerve conduction velocity Nerve conduction velocity Balance Balance Decreased Proprioception Gait velocity Gait stability Insulin sensitivity Glucose tolerance Immune function Bone mass/strength/density Collagen cross-linkage, thinning cartilage, tissue elasticity

Physiologic Questions Increased Arterial stiffness Myocardial stiffness Systolic blood pressure Diastolic blood pressure Visceral fat mass Total body fat Intramuscular lipid accumulation

Use It or Lose It Sedentary people lose large amounts of muscle mass (20-40%) Sedentary people lose large amounts of muscle mass (20-40%) 6% per decade loss of Lean Body Mass (LBM) 6% per decade loss of Lean Body Mass (LBM) Aerobic activity not sufficient to stop this loss Aerobic activity not sufficient to stop this loss Only resistance training can overcome this loss of mass and strength Only resistance training can overcome this loss of mass and strength Balance and flexibility training contributes to exercise capacity Balance and flexibility training contributes to exercise capacity

What is exercise? Lifestyle choices Lifestyle choices Organized sports Organized sports Unstructured play Unstructured play Household and Occupational tasks Household and Occupational tasks

Increased Muscle Mass Endurance training emphasis Endurance training emphasis Walking isn’t enough Walking isn’t enough Progressive resistance training Progressive resistance training DM prevention? DM prevention? Dependency prevention? Dependency prevention? Falls and fractures Falls and fractures Disuse Disuse Sarcopenia Sarcopenia Frailty Frailty

Use It and Lose Less of It Resistance training improves strength by a range of Resistance training improves strength by a range of40-150% Lean body mass increases 1-3 kg Lean body mass increases 1-3 kg Muscle fiber area 10-30% Muscle fiber area 10-30%

Body composition Genetic, lifestyle and disease factors Metabolic, cardiovascular and musculoskeletal systems impacted Lifestyle is under patient’s control Weight manangement

Burning Fat Decreases in total body adipose tissue Decreases in total body adipose tissue Aerobic and resistive training Aerobic and resistive training Energy restricted diets and/or high volume exercise (5-7 hours/week) Energy restricted diets and/or high volume exercise (5-7 hours/week) Visceral fat selectively mobilized Visceral fat selectively mobilized

What’s fat got to do with it? Metabolic syndrome Metabolic syndrome Vascular disease Vascular disease Osteoarthritis Osteoarthritis Gallbladder disease Gallbladder disease Diabetes Diabetes Hypertension Hypertension Dyslipidemia Dyslipidemia Sleep apnea Sleep apnea Breast cancer Colon cancer Endometrial cancer Impotence Osteoarthritis Depression Disability

Exercise and prevention

Diabetes and Osteoporosis Insulin Resistance Insulin Resistance Improves insulin sensitivity Improves insulin sensitivity Detraining may reduce exercise effect Detraining may reduce exercise effect Primary prevention demonstrated Primary prevention demonstrated Osteoporosis prevention and treatment Osteoporosis prevention and treatment Stabilization or increase in bone density in pre- and postmenopausal women with resistive or weight bearing exercise Stabilization or increase in bone density in pre- and postmenopausal women with resistive or weight bearing exercise 1-2% per year difference from controls 1-2% per year difference from controls

Dyslipidemia Not a lot of data in elderly Not a lot of data in elderly No clear primary and secondary prevention data No clear primary and secondary prevention data Exercise associated with less atherogenic profiles Exercise associated with less atherogenic profiles Duration and frequency factors Duration and frequency factors Weight loss (or fat loss) associated with increased HDL Weight loss (or fat loss) associated with increased HDL Gender differences with training Gender differences with training Less training effect on HDL in women Less training effect on HDL in women

Hypertension Most trials cross sectional and cohort Most trials cross sectional and cohort Lower pressures in active individuals Lower pressures in active individuals 5-10 mmHg 5-10 mmHg Type and intensity Type and intensity Greater training effect in those with mild to moderate hypertension Greater training effect in those with mild to moderate hypertension 6-7 mmHg drop in systolic and diastolic pressure 6-7 mmHg drop in systolic and diastolic pressure Effect present in low-to-moderate exercise Effect present in low-to-moderate exercise

CVD Exercise training beneficial in CVD Exercise training beneficial in CVD Reduced claudication pain Reduced claudication pain Greater walking distance Greater walking distance Improved functional endpoints Improved functional endpoints Benefit in selected patients with coronary artery disease. Benefit in selected patients with coronary artery disease.

Arthritis Improved functional status Improved functional status Faster gait Faster gait Lower depression Lower depression Less pain Less pain Less medication use Less medication use Strength and endurance training benefit Strength and endurance training benefit

Cancer Potential protective benefits with Potential protective benefits with Breast Cancer Breast Cancer Colon Cancer Colon Cancer Prostat Prostat

Exercise treatment of chronic disease May treat symptoms and disuse and not the underlying disease May treat symptoms and disuse and not the underlying disease Parkinson’s Parkinson’s COPD COPD Claudication Claudication Chronic renal failure Chronic renal failure May reduce recurrence of disease May reduce recurrence of disease CVD CVD Falls Falls

Exercise and emotional health and well being

Emotional well being Genetic, social, personality, and psychological constructs Genetic, social, personality, and psychological constructs Leading cause of death and disability in developed countries Leading cause of death and disability in developed countries

Exercise and Mental Health Positive psychologic attributes Positive psychologic attributes Lower prevalence and incidence of depressive symptoms Lower prevalence and incidence of depressive 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 training Aerobic and resistance training Higher intensities Higher intensities Meaningful improvements in depression Meaningful improvements in depression Response rates of 31-88% Response rates of 31-88% Equipotent to standard treatment Equipotent to standard treatment

Exercise and disability

Function relates to strength Non-linear relationship between strength and function Non-linear relationship between strength and function Concept of Threshold Concept of Threshold EPESE Study: EPESE Study: Physically active patients at baseline less likely to develop disability Physically active patients at baseline less likely to develop disability Exercise improves functional limitations Exercise improves functional limitations Functional balance tasks Functional balance tasks Gait speed Gait speed Arthritis Arthritis

Exercise and longevity

Exercise Evaluation

Contraindications Relative Relative Acute illness Acute illness Undiagnosed chest pain Undiagnosed chest pain Uncontrolled diabetes Uncontrolled diabetes Uncontrolled hypertension Uncontrolled hypertension Uncontrolled asthma Uncontrolled asthma Uncontrolled CHF Uncontrolled CHF Musculoskeletal problems Musculoskeletal problems Weight loss and falls Weight loss and falls Absolute Inoperable Aortic Aneurysm Cerebral aneurysm Malignant ventricular arrhythmia Critical aortic stenosis End-stage CHF Terminal illness Behavioral problems

Exercise Prescription Modes Modes General activities General activities Aerobic Aerobic Walking Walking Sports Sports Resistance Resistance Supervision/technique Supervision/technique Benefit with one set Benefit with one set Flexibility Flexibility Static stretch Static stretch Balance Balance Risk assessment Risk assessment Dynamic and static balance Dynamic and static balance Mode governed by: Duration 30 minutes Frequency Most days Intensity Borg Scale % of MHR MHR

ACSM guidelines for healthy aerobic activity Exercise 3-5 days each week Exercise 3-5 days each week Warm up 5-10 minutes before aerobic activity Warm up 5-10 minutes before aerobic activity Maintain intensity for minutes Maintain intensity for minutes Gradually decrease intensity of workout, then stretch to cool down during last 5-10 minutes Gradually decrease intensity of workout, then stretch to cool down during last 5-10 minutes If weight loss is goal, 30 minutes five days a week If weight loss is goal, 30 minutes five days a week

Aging and Aerobic Capacity Peak between Peak between Declines with age Declines with age Approximately 10% per decade after age Approximately 10% per decade after age Masters Athletes: 5% per decade Masters Athletes: 5% per decade Overall: 0.55 decline per year in VO2 max Overall: 0.55 decline per year in VO2 max Anaerobic threshold: occurs at lower work rates Anaerobic threshold: occurs at lower work rates

Benefits of Regular Physical Activity Cardiovascular health Cardiovascular health Cholesterol, HDL, LDL, VO2,RHR Cholesterol, HDL, LDL, VO2,RHR Muscular health Muscular health Strengthens bone Strengthens bone LBM enhanced/preserved LBM enhanced/preserved BMR improved/maintained BMR improved/maintained Endurance/strength improves Endurance/strength improves

More Benefits of Regular Physical Activity Reduces health risks associated with obesity Reduces health risks associated with obesity Enhances insulin action Enhances insulin action Reduces body fat Reduces body fat Reduces cancers risk Reduces cancers risk Reduces susceptibility to infections Reduces susceptibility to infections Improves peristaltic functions Improves peristaltic functions Fewer injuries Fewer injuries Reduced health care costs Reduced health care costs Psychological health Psychological health Stress and depression Stress and depression Improved QOL Improved QOL

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