Aging, Exercise,

and Cardiovascular
Health
Pkamalanathan
Associate professor of physiotherapy
SRM UNIVERSITY

Exercise and Health

o Exercise and Aging
o Exercise and disease prevention

CHD
Diabetes
Cancer
Stroke

Exercise and Aging

o
o
o
o

7-8% of adults: regular vigorous

exercise
32-36% of adults: Regular low intensity
exercise (lower than recommended)
Exercise incidence typically w/ age
* More than half of individuals who
begin regular exercise program quit
within first 6 months

Centers for Disease Control

Exercise and Aging

o

Functional capacity peaks between

20 and 30 years of age and
decreases with advancing years.
Active people show 25% higher
functional capacity at any age
over sedentary counterparts!
Physical capacity will decline w/
age, but older people can still
improve!

Exercise and Aging

o

Muscular Strength
Peaks between 20 & 30 and declines
approximately 30% by age 70

Due to reduced muscle mass (likely an

actual loss of fibers)

Muscles are still trainable

ST decreases muscle protein loss

Gains in strength (%) in elderly are
similar to those seen in the young
Increases and maintains flexibility

Exercise and Aging

o

Nervous System
37% decline in spinal cord axons
10% decline in conduction velocity
Loss of elasticity of connective tissue

Decreased RT and muscle contraction

velocity
Minimized by exercise

Pulmonary Function

Older, endurance trained individuals

score significantly higher on PFTs

Exercise and Aging

o

Cardiovascular Function
Aerobic capacity decreases 35% by
age 65
Hrmax declines with age (220-age)
SV decreases*
Reduction of blood flow due to
stenosis (Heart?)
Decreased elasticity of major
vessels

Exercise and Aging

o

Cardiovascular System Responds

to Training at any AGE!!!
Adaptations (%) similar to those
seen in younger individuals.
Decline may be 2Xs faster however.

Body Composition
Exercise diminishes increase in BF%
seen with aging

Aging vs. Sedentary Lifestyle

o

Aging and being sedentary

combined, facilitates loss of
physical capacity.
Many people blame getting
old for everything (usually lack
of activity).
Human body improves with
activity...REGARDLESS OF AGE!!!

Exercise to Improve Health

and Extend Life
o

Harvard Alumni Study (Classes

of 1920 - 1954)
Exercise improved health and
reduced mortality
Hypertensives: Reduced death
rate by 50%
Individuals with parents who
died prior to age 65: Reduced
death rate by 25%

% Death Risk Reduction

Harvard Alumni Study

60
50
40
30
20
10
0
5

5 to

10 to

15 to

20 to

25 to

30 to

10

15

20

25

30

35

Miles Walked / Run per Week

Exercise to Improve Health

and Extend Life
o

Epidemiological evidence

Studies have shown a cause - effect

relationship between physical inactivity
and CHD (sedentary person = 2Xs risk)
Protective association just as strong as
hypertension, smoking, and high
cholesterol.
Physical inactivity is the GREATEST
risk factor for heart disease...more
people are physically inactive than
possess ALL other CHD risk factors!

Light Activity is Valuable

D e a t h s / 1 0 ,0 0 0

70
60
50
40
30
20
10
0
1
Low

2
3
Fitnes s Lev el

5
High

Cardiovascular Diseases
Cardiovascular diseases including:
Coronary Artery Disease (CAD)
or Coronary Heart Disease
(CHD), are the leading killer of
Americans.
Cardiovascular disease includes all
diseases associated with the
heart and / or blood vessels.

Cardiovascular Diseases
o

Cardiovascular diseases can lead to

myocardial infarction (heart attack),
stroke, embolisms, aneurysms, etc.
Incidence of deaths from heart
disease have declined since 1970
(due to advances in technology, not
decrease in CHD incidence)
Annual costs over 120 billion dollars!

Cause of Death in the USA

Other
18%
COPD
3%
Pneumonia

CVD

3%

50%

Accidents
5%

Cancer
21%

Coronary Artery Disease (CAD)

o

Coronary circulation

ALL blood supplied to heart is done so

via two coronary arteries (Right & Left)
that bifurcate from the aorta just
above the LV.
There is absolutely NO blood perfusion
from inside the chambers of the heart.
If coronary artery is blocked, the heart
may be starving for O2 all the while it is
full of oxygenated blood.

1.) Right Coronary artery

2.) Left Coronary Artery

Coronary Artery Disease

(CAD)
o

o
o

Degenerative changes involving the lining

of major vessels supplying blood to the
heart.
Various compounds interact with these
changes (injured areas) including the
oxidative reaction of LDL-C to form a fatty
streak.
This is the first sign of atherosclerosis.
Eventually a plaque is formed and the body
will respond by generating scar tissue.

Coronary Artery Disease

(CAD)
o
o

All of these lead to a narrowing of the

CA.
Eventually causes the myocardium
(heart muscle) to become ischemic, or
poorly supplied with oxygenOften
associated with angina or chest pains.
Blood flow may become very slow and
turbulent causing development of a
clot or thrombus.

Myocardial Infarction
o

Myocardial Infarction:

The result of inadequate perfusion of

blood in the coronary arteries. Caused
by a significant reduction in the
diameter of the vessel (most often
caused by a thrombus).
Many people suffer MIs without ANY
prior symptoms!
Mortality rate decreases in individuals
who are exercise trained.

Symptoms Suggestive of CAD

Pain or discomfort in chest, jaw, or

arm*
Shortness of breath*
Dizziness*
Orthopnea (diff. Breathing when
supine)
Ankle edema (chronic)
Claudication*
Unusual fatigue or dyspnea with light

CAD Begins Early

o Fatty streaks are common in
children as young as 5 yrs.
o Studies examining autopsy
results of Vietnam
casualties (avg. age 19 yrs.)
showed significant CAD in
majority of men.

Risk Factors for CAD

o

Modifiable

Obesity
Sedentary life
Blood lipids
Diet
Hypertension
Smoking
Diabetes
Tension & stress
Education

Non-Modifiable
GENETICS *

Family History*
Race
Sex

Age

Modifiable Risk Factors

Minimizing modifiable risk factors is our
best defense against developing
CAD!
It is impossible to weight various risk
factors, because of the role of
genetics. Some people simply dont
develop heart disease because of
the presence of a certain risk factor,
when some one else may.

Modifiable Risk Factors

o Primary Risk Factors

Lipid levels (cholesterol)

Blood pressure
Smoking
Physical Inactivity

Modifiable Risk Factors

o

Blood lipid abnormalities

Actual mechanism is not yet fully
understood

However, strong statistical link with TC,

LDL-C, & HDL-C and incidence of CAD.
TC < 200 mg/dL
LDL-C < 130 mg/dL
HDL-C > 35 mg/dL
TG < 135 mg/dL (males) 160 mg/dL
(females)

Modifiable Risk Factors

o
o
o

LDL-C transports cholesterol

from the liver to the cells of the
body (arteries)
HDL-C removes cholesterol from
body cells and transports it to
the liver for excretion as bile.
TC / HDL-C ratio is the best
indicator of a favorable lipid
profile (<4.5)

Modifying Blood Lipid Levels

o

Favorable Effects

Weight loss
Exercise
High water-soluble
fiber intake
High polyunsat.
saturated fat ratio
Intake of omega-3
fatty acids (fish)
Moderate alcohol
consumption

Unfavorable
Effects

Smoking
Diet high in
saturated fat and
cholesterol
Stress
Oral contraceptives
Sedentary lifestyle

Modifying Blood Lipid Levels

o

o
o

Blood lipids are still very

dependant on a persons genetic
makeup!
Some people respond to diet and
exercise, some require medication.
Lowering elevated lipids is
extremely important for
minimizing CAD risk!

Hypertension
o Elevated blood pressure may
be caused by several things;
HTN is result of either:
Excessive vasoconstrictor tone*
Arteriosclerosis: hardening of
arteries

High blood volume

Hypertension
o

High blood pressure is defined as

resting systolic > 140 mm/Hg
and/or diastolic > 90 mm/Hg.
Incidence increases with:

Family history
High Na+ intake
Stress
Obesity
Kidney ailments
Smoking

Hypertension
o

Often called silent killer

Most people do not know they
have it
90% of causes are of unknown
etiology (essential hypertension)
Uncorrected, HT can lead to heart
failure, heart attack, stroke, and
kidney failure.
Exercise is often the best way
lower borderline hypertension.

Smoking
o
o

Increases CAD risk 2X & stroke risk

5X.
Smoking has negative effect on
blood lipids and increases
incidence of hypertension.
Each cigarette smoked equates to
a loss of seven minutes of life
Americans loose 5 million years of
potential life annually to smoking!

Physical Inactivity
o

Exercise protects against CAD by:

Normalizing blood lipid profile (increased
HDL-C and lowered LDL-C)
Lowered blood pressure and HRrest (less
physical demand / work on myocardium)
Improving myocardial circulation and
metabolism (protects heart during hypoxic
stress)

Increased vascularization
Increased glycogen stores and anaerobic capacity

Physical Inactivity
o Exercise protects against
CAD by:
Increased myocardial
contractility & vascularization
Developing a more favorable
body composition
Decreases clot formation
Reduces stress and tension

Obesity
o

o
o

Determining importance of obesity

as a risk factor is difficult since it is
almost always seen in conjunction
with other risk factors.
Overweight (>30% BF) see a 70%
increased mortality risk.
Increased risk of CAD, diabetes,
and stroke.

Diabetes
o
o
o

High blood glucose levels increase

degeneration seen in vessels.
Diabetics often have circulatory
problems throughout the body.
High blood sugar levels will irritate
plaques in CA and increase likely
hood of them enlarging and/or
developing clots

Diabetes and Exercise

o
o

Most diabetics are Type II, adult onset.

Exercise and obesity are the two
largest risk factors for Type II diabetes.

Most often caused by insulin receptor

insensitivity (brought on by huge
fluctuations in blood sugar)

Most Type II diabetics can control blood

glucose with diet and exercise and can
often live completely free of insulin
therapy.

Stress, Tension, & Type As

o

Increased incidence of CAD is

seen in individuals with high
levels of stress, self reported
tension, or who are classified
as Type A personalities.

RELAX!

Non-modifiable Risk Factors

o
o
o

Family History: Likely the most

POTENT risk factor!
Age: Incidence increases with age.
Sex: Females have less CAD at any
given age than male counterparts.
(Protective mechanisms of estrogen)
Race: Different races show different
CAD rates (Genetics, diet, and
lifestyle)

Risk Factors (Summary)

o

Age: Males > 45 yrs , Females > 50

yrs
Sex: Males > Females
Family History: exponentially worse if
both parents have positive history
Lipids:

o
o
o

TC<200 TG<135 160

HDL-C > 35 LDL-C < 130

Blood Pressure: < 140 / 90 mm/Hg

Risk Factors (Summary)

o
o
o
o
o
o

Physical Inactivity
Diet high in fat and cholesterol
Smoking
High BF% (Obesity)
Diabetes
Stress and tension

CAD Incidence / 100,000

Interaction of Risk Factors

600
500
400
300
200
100
0

None

One

Two

CAD Risk Factors

Three