Technologys role in reaching and maintaining healthy life styles

1
Technologys role in reaching and maintaining
healthy life styles

• Remarks for the meeting of the Dutch Ministry of
  Health, Welfare and Sport, November,13,2007
• Technische Universiteit Eindhoven
• James L. Fozard, Ph.D.
• University of South Florida
• Tampa, FL 33618 USA

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My second interaction with the Dutch Ministry of
Health, Welfare and Sport

• In 1996, A symposium, Problems and solutions in
  longitudinal research was held in honor of the
  20th anniversary of the Amsterdam Growth and
  Health Longitudinal Study
• Opening address by Secy Erica Terpstra
• I served as one of the two peer reviewers for the
  13 invited papers published in the International
  Journal of Sports Medicine, July 1997, 18, Suppl
  3, S139-S254

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Importance of Healthy lifestyle begins early in
life

• Lessons from many longitudinal studies of growing
  childrenespecially teenagersshow a strong
  relationship between healthy lifestyles with
  respect to cardiovascular risk factors observed
  in young adulthood
• Two examples follow
• The Bogalusa Heart Study
• The Amsterdam Growth Study

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Cardiovascular risk factors in childhood carry
over to adulthood

• Blood pressure and other cardiovascular risk
  factors were measured in 1500 boys and girls
  ranging age from 5-14 years and again 15 years
  later. Over 18 of the adults who were in the
  highest quintile of blood pressure as children
  developed essential hypertension as opposed to 5
  in the lower quintiles
• Bao W, Threefoot SR, Strinivasen SR, Berenson GS.
  Essential hypertension predicted by tracking of
  elevated blood pressure from childhood to
  adulthood The Bogalusa Heart Study. Amer J
  Hypertension 1995, 8(7), 1-8
• Twisk J Tracking of blood cholesterol over a 15
  year peiod and its relation to other risk factors
  for coronary heart disease. Den Haag, NL
  CIP-Data Koninklijk Bibliotheek, 1995

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Activity(Weighted Mets) and VO2 max in childhood
and young adulthood
Mets
Age in Years
Data from Fig. 12Kemper HCG,The Amsterdam Growth
and Health Longitudinal Study Int. J Sports Med.
1997, 18 S140-S150.
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Normal FEV1 changes in adulthood

• A longitudinal study of normal changes in VO2 Max
  showed that the decline in VO2 max follows a
  constant percentile. If you were in the 80th
  percentile of your height group at age 50, you
  would be in the 80th percentile when you were 70
  even though the VO2 value would be be lower at
  age 70
• Pearson JD, Kao SY, Brant LJ, Metter EJ, Fozard
  JL. Longitudinal changes in forced expiratory
  volume in healthy, nonsmoking men and women The
  Baltimore Longitudinal Study of Aging. Am J Human
  Biol., 1998,10,471-481.

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Rapid change in FEV1 in adulthood is an
independent risk factor for cardiac death

• The rate of change in FEV1 over many biannual
  observations was estimated for each of over 800
  male participants in the Baltimore Longitudinal
  Study of Aging who were free of pulmonary and
  cardiovascular disease at time of first
  measurement.
• The rates of change were used in a risk factor
  analysis
• The major result was that the odds ratios for
  cardiac death increased with higher rates of
  decline in both smokers and nonsmokers
• Tockman MS, Pearson JD, Metter EJ, Kao SY Rampal
  KG, Cruise LF, Fozard JL. Rapid decline in FEV1
  A new risk factor for coronary heart disease
  mortality. J Resp. Critical Care Med.,
  1995,151,390-398

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Extended Health requires us to change how we
think about aging

• Negative stereotypes about old age and aging are
  detrimental to the well being and personal
  fulfillment of young and old alike
• Agism is apparent in many jokes
• Pervasive negative stereotypes about aging
• Poor parental training about aging to the young
• Poor appreciation of individual differences

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Lets change our way of thinking about aging

• Pervasive negative stereotypes about aging
• If I knew I was going to live this long, I would
  have taken better care of myself
• One senior to another When does old age begin?
  Answer Later
• Young adults most serious life decision?
• Answer When to begin middle age

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Lets change our way of thinking about aging

• Poor parental training of the young about aging
• Dennis the Menace to his fathers friend What
  age are you in the middle of?
• Child to grandmother If Im only young once,
  how many times do I have to be old?

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Lets change our way of thinking about aging

• Poor appreciation of individual differences
• Old man answers question about his age What age
  do you mean--My anatomical, physiological,
  psychological, or chronological?
• This gentleman is both smart and wise, smart
  because of the critical distinctions and wise
  because chronological age is at the end of the
  list
• When asked what his doctor thought about his
  lifestyle choices at age 100, George Burns
  replied, I dont know, my doctors dead.

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Technology can help education and training
activities related to aging

• Simulations can help educate people for aging in
  various situations (BJ Fogg)
• Cause and effect simulations (social skills)
• Environmental simulations (treat phobias)
• Object simulations (drunk driver)
• Simulations of aging for young people can reduce
  negative attitudes toward aging

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Virtual simulations of aging and healthy
lifestyles

• Since the 1970s, many simulations of age related
  sensory and mobility limitations have been
  devised to educate the young
• Clouded lenses, ear plugs, gloves, weighted shoes
  etc.
• Limitation is lack of linkage of these devices
  and preventive and compensatory interventions
• Virtual reality simulations can improve education
  by linking simulations of limitations to effects
  of compensatory and preventive measures

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Old Adults perform ADLs closer to max strength
than young adults

• Hortobagyi T, Mizelle C, Beam S, DaVita P. J.
  GerontologyMedical Sciences, 2003, 58A,453-460.

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Purpose/Methods

• Walking, going up and down stairs and rising from
  chair requires relatively higher percentage of
  maximum reserve capacity in older than younger
  adults--True for cardiovascular and muscle
  function
• Study measured relative effort to perform these
  tasks by assessing maximal leg strength on a
  machine and by the force used when going up or
  down stairs or standing up from a chair. Force
  was measured by special recording plate embedded
  in the floor or steps
• Participants were healthy women in two age groups
  mean ages 22 and 74 years.

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Relative effort () of maximum strength required
to perform ADLs
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Long-Term Consequences of Age Differences in
Strength

• Midlife strength predicts functioning 25 years
  later
• Grip strength measured at age 45 to 68 in
  Japanese-American men. 25 years later speed of
  walking, ability to stand up from chair, and
  self-reports of difficulty lifting 10 lbs, doing
  housework, etc were measured.
• Rantanen T, Guralnik JM, Masaki K et al Midlife
  hand grip strength as a predictor of old age
  disability JAMA 1999281558-560

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with Limitations in Strength Groups Measured 25
Yrs Ago
Data from Rantanen et al, JAMA 1999281559
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Effects of strength training on mobilitybasic
findings

• Strength training and physical activity improve
  muscle mass, control of movement, and balance
• Fiaterone MA, Marks EC, Ryan ND et al.
  High-intensity strength training in
  nonogerniansEffects of skeletal muscle. J Am Med
  Ass, 19902633029.
• Ivey FM, Tracy BL, Lemmer JT, NessAiver M, SM,
  Metter EJ, Fozard JL, Hurley BH. The effects of
  strength training and detraining on muscle
  quality Age and gender comparisons J
  GerontolBiol Sci 200055AB152-B157.
• Miller ME, Rejeski WJ, Reboussin BA, Ten Have TR,
  Ettinger WH Physical activity, funtional
  limitations and disability in older adults J Am
  Ger Soc 2000481264-1272.
• Since 2000, dozens of well designed studies
  extend these early studies e.g., J. Gerontology
  Med Sci 200762A(June)2007 62A(Aug)

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Young Men Young Women Older Men
OlderWomen
Muscle Quality(MQ) is strength/volume. Strength
training of right leg occurred over 9 months
detraining over 31 weeks. From Ivey et al 2000
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Strength and Gait Speed

• Leg exension strength and leg power correlate
  with gait speed. The distributions of leg power
  associated with different speeds may provide the
  basis for setting goals for strength needed for
  walking.
• Rantanen T, Avela J Leg extension power and
  walking speed in very old people living
  independently. J Gerontol Med Sci
  199752AM225-M331.
• Correlations between power and speed ranged from
  .4 to.7 in old people
• Kwon I, Oldaker S, Schrager MA, Talbot LA, Fozard
  JL, Metter EJ. Relationship between muscle
  strength and self-paced gait speed Age and sex
  effects. J Gerontol Biol Sci 200156BB398-B404

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Cumulative distributions of leg power for 5
groups of walking speed from lt1m/s togt2m/s Data
from Rantanen andAvela 1997
Cum
Leg power is expressed as Watts/kg
Note that the cumulative of leg power at 1m/s
ranged from 1-3 W/kg The cumulative of leg
power at 2m/s ranged from 8-15.5 W/kg
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Technology and setting goals for strength
training

• Prevention requires that we set standards for
  reserve strength needed for adequate functioning
  at a later age
• Early estimates--we need 40 of our strength at
  age 25 to function well at age70
• Wearable transducers provide information on
  quality and required number of maneuvers
• New technology development at University of Pisa
  by Dr. E. Piaggio allows for Kinesthetic sensing
  by use of smart fabrics in gloves, socks and
  leotards
• http//www.piaggio.ccii.unipi.it/kine.htm

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Networking improves coaching in strength training

• Motivation is major issue for utilizing strength
  trainingmachines can have motivational
  properties
• Networking can improve motivation and quality of
  feedback from strength training
• Reinforcement from sharing information by peers
  doing similar workouts

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Technology and motivation Computerized coaching

• FitLinxx is a computerized system that attaches
  directly to existing fitness equipment
• FitLinxx learns users' programs, coaches them
  individually through their workout for better
  form, safety and confidence during every
  exercise, and tracks their progress over time.
• On strength equipment, FitLinxx appears as an
  easy-to-read touch-screen display that's attached
  to the machine. For cardiovascular equipment,
  each machine's existing console is simply
  networked to FitLinxx
• Users simply tap in their PIN to display their
  targets - FitLinxx then coaches them on speed,
  form, heart rate, etc., and tracks the workout
  session - every rep, set and step.
• http//www.fitlinxx.com/Article.htm?ID976