Physical Activity

1. Physical activity and cardio-vascular prevention Graziano Onder Centro Medicina dell’Invecchiamento Università Cattolica del Sacro Cuore Rome - Italy

2. Factors for successful aging Male and female aging Environmental factors Metropolitan/rural area, personal environmental, injuries Social factors Education, social support, prevention, abuse Economical factors Type of work. Personal factors Biology, genetic factors Successful aging Social and Health services Promotion of health, primary and secondary prevention, long-term care Life style Physical activity, nutrition, smoke, alcohol, drugs abuse 0NU 2002

3. EXERCISE IN THE ELDERLY THE ROLE OF EXERCISE IN THE ELDERLY In the young-old, exercise has much the same function as in the young: - prevention of disease - maintenance of aerobic capacity - maintenance of muscle strength - psychological well-being

4. b) In the old-old, exercise is still used for its preventive effects, but more often for: - secondary or tertiary prevention - rehabilitation from pre-existing chronic conditions c) Some of the most important goals of exercise in the frail elderly are: - the improvement of muscle strength and endurance capacity to allow increased functional independence

6. Characteristics of study poplulation according to physical activity

7. Risk of disability according to physical activity

9. adjunctive treatment of depression, anxiety, isolation, insomnia, dementia- rehabilitation from neurologic diseases

11. Crude and adjusted relative risk of mortality Adjusted for gender and for all other possible risk factors for death (gender, physical and cognitive disability, cardiovascular diseases, pneumonia, cancer, stroke, diabetes, chronic obstructive pulmonary disease, renal failure, Parkinson’s disease, depression, delirium, and arthritis).

12. Preventive Medicine 47 (2008) 422–426

13. Crude and adjusted relative risks (RRs) of mortality in the Italian cohorts of the ilSIRENTE study, examined at baseline between 2003 and 2004 and after 24 months Sedentary: subjects walking less than 1 h per day; Active: subjects walking 1 h or more per day. Adjusted for age, gender and for other possible risk factors for death (functional and cognitive disability, congestive heart failure, hypertension, osteoarthritis, depression, number of medications, body mass index, cholesterol and C reactive protein).

14. Incidence of Coronary Heart Disease Honolulu HeartProgram 2678 activemen Age: 71-93 years FU: 2 to 4 years Hakimet al. Circulation 1999

15. Estimated rates of AMI Men Women Men Women Mittleman et al. NEJM 1993

16. Association between physical activity and stroke Case controlstudy 1047 men and women Age: 70 years Sacco et al. Stroke 1998

17. Mediators ?

18. Physicalactivity - Lipids Observationalstudy 380 men and women Age: 68 years FU: 10 years % change Petrellaet al. Diabetes Care 2005

19. Physicalactivity – Body composition 173 women Age: 55-70 years Irwinet al. JAMA 2003

20. Physicalactivity – Diabetes 3234 non-diabeticAge: 50 years FU 2.8 years Knowleret al. NEJM 2003

21. Physicalactivity – Glucoseintolerance 424 menAge: 74 years FU 5 years Van Dam et al. Med Sci SportsExerc 2002

22. Physicalactivity and inflammation Gaffkenet al. Am J Epidemiol. 2001

23. Physicalactivity – Hypertension Wheltonet al. AnnInternMed 2002

24. Mediators Antiatherogeniceffects Antithromboticeffects ↓plasma fibrinogen levels ↑ plasminogen activator ↑ active tissue plasminogen activator ↓ plasminogenactivatorinhibitor Endothelialfunctionalteration release of endothelium-derivedrelaxing (NO) Fletcher et al. Circulation 2002

25. Mediators Autonomicfunctionalchanges ↑ parasympatheticactivity Anti-ischemiceffects ↓ myocardial work (↓ BP and HR) Antiarrhythmiceffects improved myocardial oxygen supply-demand balance ↓ in sympathetic tone and catecholaminerelease ↑ ventricularfibrillation duringstrenuousexercise Fletcher et al. Circulation 2002

26. Whichtype of intervention? Dynamicaerobic (endurance) exercise – running or walking Dynamicresistanceanaerobic (strength) exercise – weight lifting

27. Endurance

28. Endurance

29. Resistance

30. Resistance

31. Endurance training Bloodpressure Cardiac output Vascularresistance Stroke volume Heart rate Cornelissenet al. Hypertension 2005

32. Resistance training Cornelissenet al. J Hypert 2005

33. Resistance and endurance training Williams et al. Circulation 2007

34. Resistance training For persons at moderateto high risk of cardiac events, RT can be safely undertaken withproper preparation, guidance, and surveillance … given the extensive evidence of the benefits of aerobicexercise training on the modulation of cardiovascular risk factors,RT should be viewed as a complement to rather than a replacementfor aerobic exercise. Williams et al. Circulation 2007

35. Training - Guidelines FrequencyIntensityDurationModality Endurance training 3–5 days/week 50%–70% max HR 20–60 min Lower extremity: walking, jogging/running,stairclimber Upper extremity: arm ergometry Combined: rowing, cross- country ski machines, combinedarm/leg cycling, swimming, aerobics Resistance training 2–3 days/week 1–3 sets of 8–15 RM Lower extremity: leg for each musclegroup extensions, leg curls, leg press, adductor/abductor Upper extremity: biceps curl, triceps extension, bench/overhead press. Fletcher et al. Circulation 2002

36. Age-AssociatedAlterations in PhysiologicalResponsetoAerobicExercise Reduced aerobic capacity: decline in V˙ O2 max of 8% to 10% per decade in nontrainedpopulations Reduced maximal heart rate of 1 beat/min per year More rapid increase in systolic blood pressure with exercise Attenuated rise in ejection fraction Fletcher et al. Circulation 2002

37. Classification of Physical Activity Intensity MET=metabolic equivalents 1 MET = resting metabolic rate of 3.5 mL O2 * kg-1 * min-1 Fletcher et al. Circulation 2002

38. Bottle exercise PHYSICAL ACTIVITY = MEDICINE If exercise could be packed into a pill, it would be the single most widelyprescribed, and beneficial,medicine Robert N. Butler, M.D. Director, National Institute on Aging

40. Soft tissue injury

41. Falls

43. Hernia

44. Hemorrhage

46. Acute myocardial infarction

47. Hypoglycemia in persons with diabetes

48. Orthostatic hypotension

50. LIFE-P – Side effects Pahor et al J Gerontol A Biol Sci Med Sci 2006

52. Physical

53. Cardiovascular reserve: get up and down from the examination table, walking 15 m, climbing 1 flight of stairs, cycling in the air for 1 min while lying down

54. ECG Gill et al JAMA 2000

55. Exercise in the Elderly- Screening It is not necessary that all individuals beginning a moderate-intensity and moderately progressive exercise program undergo an exercise stress test, although this issue remains controversial. Gill et al JAMA 2000

57. Extended cool-down period after physical activity

58. Importance of range of motion and flexibility exercises

59. Evaluation of participant’s footwear

60. Evaluation of thermoregulatory capacity of participantGill et al JAMA 2000

61. Majority of Americansdo not follow healthy lifestyle 2000 Behavioral Risk Factor Surveillance System, N = 153,805 100 77.8 76.7 80 59.9 60 Respondents (%) 40 24.0 20 0 Smokers BMI ≥25 kg/m2 Consumes fruits/vegetables <5x/day Infrequentexercise(<5x/week) Reeves et al. Arch Intern Med. 2005

62. Conclusions People of all ages, both male and female, benefit from regular physical activity Significant health benefits can be obtained by including a moderate amount of physical activity on most, if not all, days of the week Additional health benefits can be gained through greater amounts of physical activity

63. Conclusions Physical activity reduces the risk of premature mortality in general, and of coronary heart disease, hypertension, stroke, and diabetes mellitus in particular Bothaerobic (endurance) and resistence training mayinfluencehealthoutcomes Potentialrisksrelatedtophysicalactivityshouldbealwaysconsidered

64. Søren Kierkegaard in 1847 in a letter to his sister in law who had just been ill. ”Do not give up your wish to walk. I walk every day and feel well and walk away from any illness. I have had my best thoughts while walking and I do not know of any thoughts so dark that I can not walk away from them…”