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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. Chronological age - number of years lived Physiologic age - age by body function

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physiological aging process role of exercise

Physiological aging process &role of exercise

Dr_R.heidarimoghadam (MD&PhD)

Exercise physiologist

definition of aging
DEFINITION OF AGING
  • Old and aging depends on the age and experience of the speaker.
  • Chronological age - number of years lived
  • Physiologic age - age by body function
  • Functional age - ability to contribute to society
chronological categories
CHRONOLOGICAL CATEGORIES
  • Young-Old - (ages 65 - 74)
  • Middle-Old - (ages 75 - 84)
  • Old-Old - (age 85 and older)
physiological theories of aging

PHYSIOLOGICAL THEORIES OF AGING

What causes the body to age?

program theory

PROGRAM THEORY

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

error theory
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

CELLULAR THEORY

Normal wear and tear causes cells to function improperly

free radical theory
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
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

COLLAGEN THEORY OF AGING

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

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

NONE OF THESE THEORIES TOTALLY ACCEPTED

Scientists hypothesize it might be combination of several or all

respiratory system
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
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
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 system1
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
NEUROLOGICAL SYSTEM
  • Neurons of central and peripheral nervous system degenerate
  • Nerve transmission slows
  • Hypothalamus less effective in regulating body temperature
  • Reduced REM sleep, decreased deep sleep
  • After 50% lose 1% of neurons each year
musculosceletal system
MUSCULOSCELETAL SYSTEM
  • Adipose tissue increases with age
  • Lean body mass decreases
  • Bone mineral content diminished
  • Decrease in height from narrow vertebral spaces
  • Less resilient connective tissue
  • Synovial fluid more viscous
  • May have exaggerated curvature of spine
goals
Goals
  • Develop an understanding of normal aging physiology
  • Incorporate aerobic and resistance exercise into treatment and prevention plans of the elderly
  • Appropriate pre-exercise assessment
physiologic changes with aging board questions
Physiologic changes with aging (Board Questions)
  • Decreased
    • Muscle mass
    • Muscle strength
    • Muscle power
    • Muscle endurance
    • Muscle contraction velocity
    • Muscle mitochondrial function
    • Muscle oxidative enzyme capacity
physiologic changes with aging board questions1
Decreased

Maximal and submaximal aerobic capacity

Cardiac contractility

Maximal heart rate

Stroke volume and cardiac output

Nerve conduction velocity

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 changes with aging (Board Questions)
physiologic questions
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
Use It or Lose It
  • Sedentary people lose large amounts of muscle mass (20-40%)
  • 6% per decade loss of Lean Body Mass (LBM)
  • Aerobic activity not sufficient to stop this loss
  • Only resistance training can overcome this loss of mass and strength
  • Balance and flexibility training contributes to exercise capacity
what is exercise
What is exercise?
  • Lifestyle choices
  • Organized sports
  • Unstructured play
  • Household and Occupational tasks
increased muscle mass
Increased Muscle Mass
  • Endurance training emphasis
    • Walking isn’t enough
  • Progressive resistance training
    • DM prevention?
    • Dependency prevention?
    • Falls and fractures
    • Disuse
    • Sarcopenia
    • Frailty
use it and lose less of it
Use It and Lose Less of It
  • Resistance training improves strength by a range of

40-150%

  • Lean body mass increases 1-3 kg
  • Muscle fiber area 10-30%
body composition
Body composition
  • Genetic, lifestyle and disease factors
  • Metabolic, cardiovascular and musculoskeletal systems impacted
  • Lifestyle is under patient’s control
  • Weight manangement
burning fat
Burning Fat
  • Decreases in total body adipose tissue
    • Aerobic and resistive training
    • Energy restricted diets and/or high volume exercise (5-7 hours/week)
    • Visceral fat selectively mobilized
what s fat got to do with it
Metabolic syndrome

Vascular disease

Osteoarthritis

Gallbladder disease

Diabetes

Hypertension

Dyslipidemia

Sleep apnea

Breast cancer

Colon cancer

Endometrial cancer

Impotence

Osteoarthritis

Depression

Disability

What’s fat got to do with it?
diabetes and osteoporosis
Diabetes and Osteoporosis
  • Insulin Resistance
    • Improves insulin sensitivity
    • Detraining may reduce exercise effect
    • Primary prevention demonstrated
  • Osteoporosis prevention and treatment
    • Stabilization or increase in bone density in pre- and postmenopausal women with resistive or weight bearing exercise
    • 1-2% per year difference from controls
dyslipidemia
Dyslipidemia
  • Not a lot of data in elderly
  • No clear primary and secondary prevention data
  • Exercise associated with less atherogenic profiles
  • Duration and frequency factors
  • Weight loss (or fat loss) associated with increased HDL
  • Gender differences with training
    • Less training effect on HDL in women
hypertension
Hypertension
  • Most trials cross sectional and cohort
  • Lower pressures in active individuals
    • 5-10 mmHg
    • Type and intensity
  • Greater training effect in those with mild to moderate hypertension
    • 6-7 mmHg drop in systolic and diastolic pressure
    • Effect present in low-to-moderate exercise
slide39
CVD
  • Exercise training beneficial in CVD
    • Reduced claudication pain
    • Greater walking distance
    • Improved functional endpoints
  • Benefit in selected patients with coronary artery disease.
arthritis
Arthritis
  • Improved functional status
  • Faster gait
  • Lower depression
  • Less pain
  • Less medication use
  • Strength and endurance training benefit
cancer
Cancer
  • Potential protective benefits with
    • Breast Cancer
    • Colon Cancer
    • Prostat
exercise treatment of chronic disease
Exercise treatment of chronic disease
  • May treat symptoms and disuse and not the underlying disease
    • Parkinson’s
    • COPD
    • Claudication
    • Chronic renal failure
  • May reduce recurrence of disease
    • CVD
    • Falls
emotional well being
Emotional well being
  • Genetic, social, personality, and psychological constructs
  • Leading cause of death and disability in developed countries
exercise and mental health
Exercise and Mental Health
  • Positive psychologic attributes
  • Lower prevalence and incidence of depressive symptoms
  • Reversal of hippocampal volume loss?
  • Reversal of cognitive loss?
  • 14 randomized, controlled trials:
    • Aerobic and resistance training
    • Higher intensities
    • Meaningful improvements in depression
    • Response rates of 31-88%
    • Equipotent to standard treatment
function relates to strength
Function relates to strength
  • Non-linear relationship between strength and function
    • Concept of Threshold
  • EPESE Study:
    • Physically active patients at baseline less likely to develop disability
  • Exercise improves functional limitations
    • Functional balance tasks
    • Gait speed
    • Arthritis
contraindications
Relative

Acute illness

Undiagnosed chest pain

Uncontrolled diabetes

Uncontrolled hypertension

Uncontrolled asthma

Uncontrolled CHF

Musculoskeletal problems

Weight loss and falls

Absolute

Inoperable Aortic Aneurysm

Cerebral aneurysm

Malignant ventricular arrhythmia

Critical aortic stenosis

End-stage CHF

Terminal illness

Behavioral problems

Contraindications
exercise prescription
Modes

General activities

Aerobic

Walking

Sports

Resistance

Supervision/technique

Benefit with one set

Flexibility

Static stretch

Balance

Risk assessment

Dynamic and static balance

Mode governed by:

Duration

30 minutes

Frequency

Most days

Intensity

Borg Scale 12-14

55-75% of MHR

MHR

Exercise Prescription
acsm guidelines for healthy aerobic activity
ACSM guidelines for healthy aerobic activity
  • Exercise 3-5 days each week
  • Warm up 5-10 minutes before aerobic activity
  • Maintain intensity for 30-45 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
aging and aerobic capacity
Aging and Aerobic Capacity
  • Peak between 15-30
  • Declines with age
  • Approximately 10% per decade after age 25-30
    • Masters Athletes: 5% per decade
    • Overall: 0.55 decline per year in VO2 max
  • Anaerobic threshold: occurs at lower work rates
benefits of regular physical activity
Benefits of Regular Physical Activity
  • Cardiovascular health
    • Cholesterol, HDL, LDL, VO2,RHR
  • Muscular health
    • Strengthens bone
    • LBM enhanced/preserved
      • BMR improved/maintained
    • Endurance/strength improves
more benefits of regular physical activity
More Benefits of Regular Physical Activity
  • Reduces health risks associated with obesity
    • Enhances insulin action
    • Reduces body fat
  • Reduces cancers risk
  • Reduces susceptibility to infections
  • Improves peristaltic functions
  • Fewer injuries
  • Reduced health care costs
  • Psychological health
    • Stress and depression
  • Improved QOL
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