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Physiological aging process

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Physiological aging process &role of exercise Dr_R.heidari moghadam (MD&PhD) Exercise physiologist What s fat got to do with it? Metabolic syndrome Vascular disease ... – PowerPoint PPT presentation

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Title: Physiological aging process


1
Physiological aging process role of exercise
  • Dr_R.heidari moghadam (MDPhD)
  • Exercise physiologist

2
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

3
CHRONOLOGICAL CATEGORIES
  • Young-Old - (ages 65 - 74)
  • Middle-Old - (ages 75 - 84)
  • Old-Old - (age 85 and older)

4
PHYSIOLOGICAL THEORIES OF AGING
  • What causes the body to age?

5
PROGRAM THEORY
  • Cells replicate a specific number of times and
    then die. Happens again, and again in lab
    experiments.

6
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

7
CELLULAR THEORY
  • Normal wear and tear causes cells to function
    improperly

8
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

9
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

10
COLLAGEN THEORY OF AGING
  • As we age, collagen in body ages also. Causes
    hypertension and other organ malfunctions

11
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

12
NEURO-AGING THEORY
  • All cells undergo nervous system degeneration
  • Results in changes in hormonal release
  • Leads to decline in cell function

13
NONE OF THESE THEORIES TOTALLY ACCEPTED
  • Scientists hypothesize it might be combination of
    several or all

14
PHYSIOLOGICAL AGING OF THE HUMAN BODY BY
SYSTEMS
15
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

16
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

17
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

18
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

19
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

20
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

21
Exercise and Aging
22
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

23
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24
Exercise and aging physiology
25
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

26
Physiologic changes with aging (Board Questions)
  • 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

27
Physiologic Questions
  • Increased
  • Arterial stiffness
  • Myocardial stiffness
  • Systolic blood pressure
  • Diastolic blood pressure
  • Visceral fat mass
  • Total body fat
  • Intramuscular lipid accumulation

28
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

29
What is exercise?
  • Lifestyle choices
  • Organized sports
  • Unstructured play
  • Household and Occupational tasks

30
Increased Muscle Mass
  • Endurance training emphasis
  • Walking isnt enough
  • Progressive resistance training
  • DM prevention?
  • Dependency prevention?
  • Falls and fractures
  • Disuse
  • Sarcopenia
  • Frailty

31
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

32
Body composition
  • Genetic, lifestyle and disease factors
  • Metabolic, cardiovascular and musculoskeletal
    systems impacted
  • Lifestyle is under patients control
  • Weight manangement

33
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

34
Whats 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

35
Exercise and prevention
36
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

37
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

38
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

39
CVD
  • Exercise training beneficial in CVD
  • Reduced claudication pain
  • Greater walking distance
  • Improved functional endpoints
  • Benefit in selected patients with coronary artery
    disease.

40
Arthritis
  • Improved functional status
  • Faster gait
  • Lower depression
  • Less pain
  • Less medication use
  • Strength and endurance training benefit

41
Cancer
  • Potential protective benefits with
  • Breast Cancer
  • Colon Cancer
  • Prostat

42
Exercise treatment of chronic disease
  • May treat symptoms and disuse and not the
    underlying disease
  • Parkinsons
  • COPD
  • Claudication
  • Chronic renal failure
  • May reduce recurrence of disease
  • CVD
  • Falls

43
Exercise and emotional health and well being
44
Emotional well being
  • Genetic, social, personality, and psychological
    constructs
  • Leading cause of death and disability in
    developed countries

45
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

46
Exercise and disability
47
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

48
Exercise and longevity
49
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50
Exercise Evaluation
51
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

52
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

53
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

54
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

55
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

56
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

57
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