whats wrong with cardio? how to keep your heart from weakening, your lungs from shrinking, and your...
TRANSCRIPT
What’s Wrong With Cardio?How to keep your heart from weakening,
your lungs from shrinking, and your metabolism from dying.
Dr. Al Sears
Traditional Cardiovascular Endurance Exercise (CVE)
• CVE (“cardio”) includes activities like aerobics classes and distance jogging.
• The recommendation is to keep HR between 70 – 80% of maximum for 30 – 60 minutes
Contrary to Popular Belief “Cardio” Fails to :
1. Preserve pulmonary function
2. Decrease risk of death from cardiovascular disease
3. Reduce overall mortality
4. Recondition metabolism for achieving and maintaining optimal body composition
Pulmonary Function
Vital Capacity Declines With Age
32 37 42 47 52 57 62 67 72 7715
20
25
30
35
40
45
Men
Women
Age
Mea
n Vi
tal C
apac
ity (d
L)
Adapted from: Kannel WB, Seidman JM, Fercho W, Castelli WP. Vital Capacity and Congestive Heart Failure. The Framingham Study. Circulation. 1974;49(6):1160-1166.
FEV1 Declines With Age
Age
FEV 1 (
liter
s)
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
10 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 7920
24
28
32
36
40
44
48
52
MalesFemales
VO2m
ax (m
l/kg
/min
)
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3 rd Edition. Campaign, IL: Human Kinetics. 2005
So, what does this all mean?
Pulmonary Function – The Most Important Consequence of Aging
• Framingham researchers followed 5209 participants over 18 years
• Biggest finding: the risk of congestive heart failure increased as lung capacity decreased
• Relationship was independent of: blood pressure, relative weight, pulse, smoking status, heart enlargement, ECG-LVH, blood glucose levels, and age
• Lung volume decreased BEFORE there was any clinical evidence of CHF
Incidence of Congestive Heart Failure According to Vital Capacity
45 - 54 55 - 64 65 - 740
1
2
3
4
5
6
7
8
9
10
<4.5
4.5 - 5.1
5.2 - 5.7
>5.7
Rate
of C
HF/
1000
Vital Capacity (L/height)
Age
Adapted from: Kannel WB, Seidman JM, Fercho W, Castelli WP. Vital Capacity and Congestive Heart Failure. The Framingham Study. Circulation. 1974;49(6):1160-1166.
Even Moderate Pulmonary Impairment Increases Risk of Death
5 yr 10 yr0.5
1
1.5
2
2.5
5th
4th
3rd
2nd
1st
Years Post Follow-Up
FEV1 (%)Quintile:
Rel
ati
ve
Ris
k o
f D
eath
(al
l ca
use
s)
Cook DG, Shaper AG. Breathlessness, lung function and the risk of heart attack. Eur Heart J. 1988 Nov;9(11):1215-22.
The Age-Related Decline in Pulmonary Function Can Be Reversed with the Right Physical Challenge
Pre- and Post-Intervention Pulmonary Function
Low-Intensity Endurance Repeated All-Out Cycle Sprint
2.95
3
3.05
3.1
3.15
3.2
3.25
3.3
Pre-InterventionPost-Intervention
VO2p
eak (L
/min
)
Adapted from: Baily S, Wilkerson DiMenna F, Jones A. Influence of repeated sprint training on pulmonary O2 uptake and muscle deoxygenation kinetics in humans. J Appl Physiol. 2009 Jun;106(6):1875-87.
Training Type
Building Younger Lungs
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 1000
10
20
30
40
50
60
People participating in high-intensity interval exercise
Non-exercising control group
Max
O2 U
pta
ke (
ml/
Kg
min
)
Age
Adapted from: von Ardennne, M. Oxygen Multistep Therapy. Theime. 1990. p.31.
What We Know:
• There is an age-related decrease in pulmonary capacity
• Decreased pulmonary capacity → increased risk of heart failure
• Even moderate decreases in lung capacity → increase risk of death
• “Cardio” = does NOT reverse loss of pulmonary capacity
• High-intensity training = can completely reverse loss of pulmonary capacity.
Cardiovascular Function
High-Intensity Exercise Improves Cardiac Function – Study Design
Patients with prior MI (n = 29)
Control/no training(n = 8)
Low-intensity training(n = 11)
High-intensity training(n = 10)
Adachi H, Koike A, Obayashi T, et al. Does appropriate endurance exercise training improve cardiac function in patients with prior myocardial infarction? Eur Heart J. 1996 Oct;17(10):1511-21.
High-Intensity Exercise Improves Stroke Volume at Rest
Control Low-intensity High-intensity0
2
4
6
8
10
12
14
Adachi H, Koike A, Obayashi T, et al. Does appropriate endurance exercise training improve cardiac function in patients with prior myocardial infarction? Eur Heart J. 1996 Oct;17(10):1511-21.
Chan
ge in
stro
ke v
olum
e (m
l)
P = 0.014
High-Intensity Exercise Improves Peak O2 Uptake During Exercise
Control Low-intensity High-intensity-10
40
90
140
190
240 P = 0.030
Chan
ge in
pea
k O
2 up
take
Adachi H, Koike A, Obayashi T, et al. Does appropriate endurance exercise training improve cardiac function in patients with prior myocardial infarction? Eur Heart J. 1996 Oct;17(10):1511-21.
High-Intensity Exercise Improves Ejection Fraction During Exercise
Control Low-intensity High-intensity0
0.5
1
1.5
2
2.5
3
3.5 P = 0.024
Adachi H, Koike A, Obayashi T, et al. Does appropriate endurance exercise training improve cardiac function in patients with prior myocardial infarction? Eur Heart J. 1996 Oct;17(10):1511-21.
“Cardio” Reduces Change in Ejection Fraction
Series1
-0.6
-0.4
-0.2
1.11022302462516E-16
0.2
0.4
0.6
"Cardio"
High-intensity training
∆ Re
st to
Pea
k LV
EF (%
)
6-months 12-months
Oberman, A, Fletcher F, Lee J, et al. Efficacy of high-intensity exercise training on left ventricular ejection fraction in men with coronary artery disease (the Training Level Comparison Study). Am J Cardiol. 1995 Oct 1;76(10):643-7.
Why Does “Cardio” Fail to Deliver on its Promise?
Endurance versus Capacity
• Endurance: the degree to which one can maintain exertion over a prolonged period of time. The extended duration of the activity requires a reduction in intensity.
• Capacity: the maximum intensity of exertion reached during an activity. The high intensity of the activity requires a reduction in duration.
Consider Our Native Environment
• Natural selection favored capacity over endurance
• Selection pressures for high-capacity exertion were immediate and powerful
• Periods requiring low-intensity, longer-duration activity coincided with unfavorable conditions (war, famine, etc.). This resulted in adaptations that were functional at the time, but are dysfunctional in the modern environment.
What’s Wrong With Endurance?
• The energy required for endurance comes at the expense of capacity, resulting in a decreased cardiac reserve
• Decreased cardiac reserve lowers energy expenditure during unfavorable conditions, but comes with a considerable cost if prolonged and repeated
Cardiac Reserve and Heart Failure
Maximal level
Card
iac
Pow
er O
utpu
t* (w
)
* Cardiac Power Output = (cardiac output)(arterial pressure)
Adapted from: Williams S, Barker D, Goldspink D, Tan L. A reappraisal of concepts in heart failure: central role of cardiac power reserve. Arch Med Sci 2005; 1(2) 65-74
HARVARD ALUMNI HEALTH STUDIES
• 17,321 male alumni followed for 20 years
• High-intensity exercise was associated with a significant decrease in all-cause mortality
• No relationship between low-intensity exercise and death
Lee IM, Hsieh, CC, Paffenparger, RS Jr. Exercise intensity and longevity in men. The Harvard Alumni Health Study. JAMA. 1995;273(15):1179-1184
.
Exercise Intensity and MortalityHarvard Health Study
Low Moderate High0.84
0.86
0.88
0.9
0.92
0.94
0.96
0.98
Exercise Intensity
Rela
tive
Risk
of D
eath
(%)
Lee IM, Hsieh, CC, Paffenparger, RS Jr. Exercise intensity and longevity in men. The Harvard Alumni Health Study. JAMA. 1995;273(15):1179-1184
Improvements in Other Age-Related Bio-markers
High-Intensity Exertion Results in Improved Health Biomarkers
• 8896 recreation runners reported average exercise duration and intensity
• Relative to exercise duration, exercise intensity was associated with a:
13.3X greater reduction in systolic blood pressure
2.8X greater reduction in diastolic blood pressure
4.7X greater decrease in waist circumference
Williams P. Relationships of heart disease risk factors to exercise quantity and intensity. Arch Intern Med. 1998;158(3):237-245.
High-Intensity Exertion, But Not “Cardio”, Increases Growth Hormone
"Cardio" High-Intensity Exertion0
1
2
3
4
5
6
7
8
Felsing NE, Brasel JA, Cooper DM. Effect of low and high intensity exercise on circulating growth hormone in men. J Clin Endocrinol Metab. 1992 Jul;75(1):157-62.
∆ in
gro
wth
hor
mon
e (m
icro
gram
s/L)
P < 0.05 relative to baseline
No significant change from baseline
High-Intensity Exertion Raises Testosterone
Just 1-minute of high-intensity exertion raises testosterone by 38%
Gray AB, Telford RD, Weidemann MJ. Endocrine response to intense interval exercise. Eur J Appl Physiol Occup Physiol. 1993;66(4):366-71.
High-Intensity Exertion Dramatically Improves Blood Flow
Blood Flow (ml/min)
Rest Light Exertion
Heavy Exertion
Maximal Exertion
Brain 750 880 1,000 1,400
Coronary Vessels
250 350 750 1,100
Lungs Basic Value (BV) 1.4 x BV 3 x BV 4 x BV
Skeletal Muscle
1,200 4,500 12,500 22,000
Cardiac Output
5,800 9,500 17,500 25,000
High-Intensity Exercise Preserves Telomere Length
15 25 35 45 55 655
6
7
8
9
10
VO2max (ml/kg/min)
Mea
n le
ukoc
yte
telo
mer
e le
ngth
(kb)
R = 0.44P < 0.01
LaRocca TJ, Seals DR, Pierce GL. Leukocyte telomere length is preserved with aging in endurance exercise-trained adults and related to maximal aerobic capacity. Mech Ageing Dev. 2010 Feb;131(2):165-7.
Bottom Line:
• High-intensity exertion reverses aging
• “Cardio” does NOT!
But Doctor, what does this have to do with me?
The SolutionP.A.C.E
PROGRESSIVELY
ACCELERATING
CARDIOPULMONARY
EXERTION
Progressivity• Regular and consistent increases in the intensity of demands placed on
the cardiovascular system by making repeated changes in the same direction
• Analogous to hypertrophying skeletal muscle, training where muscle capacity is progressively increased by adding small amounts of additional weight
• KEY POINT: In PACE, high-intensity is a relative term. This means that each individual will work towards their own unique level of maximum exertion. This makes PACE the safest form of exercise
Acceleration • Training to increase the speed at which the heart and lungs respond to
increases in demand
• The same exertion level/target heart rate will be reached more quickly throughout the training process
• Recovery back to resting heart rate/respiration also happens more quickly
• KEY POINT: most cardiac arrests occur when the heart is unable to respond to a sudden and dramatic increase in demand. Training for acceleration helps the heart to respond quickly to potentially life-threatening demands – reducing the risk of sudden cardiac death
PACE -a New Exercise Principle
“Cardio” Exercise Uses Fat as Fuel
• “Cardio” trains body to use fat as fuel, training body to store energy as fat.
• Fat becomes main energy storage – NOT muscle!!
Activity Protein Carbs Fat
“Cardio” 2 – 5% 40% 55%
High-intensity 2% 95% 3%
PACE Exercise Uses Carbs as Fuel
By using carbs as fuel, PACE trains the body to store energy as ATP, creatine,
and glycogen – making muscle the main energy storage
PACE Restores Youthful Energy
Energy stored in muscle allows for IMMEDIATE access to the energy, along with a greater willingness to expend it!!
Energy Storage
Energy Release
Maximum Power
Fat
Slow
Low
Muscle
Immediate
High
The Real Magic of PACE HappensAFTER Exertion!!
• PACE ignites the body’s “after burner”
– During the 18-hours following high-intensity exertion, the body burns its fat stores in order to build more muscle!!
– High-intensity exertion results in a far greater loss of body fat compared to “cardio”
Tremblay A, Simoneau JA, Bouchard C. Impact of exercise intensity on body fatness and skeletal muscle metabolism. Metabolism. 1994 Jul;43(7):814-8.
High-Intensity Exertion Burns 9-Times More Fat Than “Cardio”
"Cardio" Hi-Intensity0
0.05
0.1
0.15
0.2
0.25
0.3
Chan
ge in
∑ o
f ski
n fo
lds
/ene
rgy
spen
t (m
m/M
J)
P<0.01
Tremblay A, Simoneau JA, Bouchard C. Impact of exercise intensity on body fatness and skeletal muscle metabolism. Metabolism. 1994 Jul;43(7):814-8.
PACE – The Twin Study
PACE Twin• Decreased body fat
by14.5%• Gained 9-lbs lean muscle
“Cardio” Twin• Decreased body fat by 5%
• Lost 2-lbs lean muscle
PACE Twin Study – Body Fat Loss
4 8 12 160
2
4
6
8
10
12
14
16
18
"Cardio"
PACEPoun
ds o
f Fat
Los
t
Weeks Post-Training
PACE Twin Study – Change in Lean Body Mass
4 8 12 16
-2
0
2
4
6
8
10
"Cardio"
PACE
Weeks Post-Training
Chan
ge in
Lea
n Bo
dy M
ass
(lbs)
Terri
PACE Case Study – Terri
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
Terri – Body Fat (%)
1 2 3 4 5 6 7 8 9 10 11 12 13 1420
25
30
35
40
45
50
55
Body
Fat
(%)
Months Post-Training
Terri - Triglycerides
Baseline 3-months 6-months170
190
210
230
250
270
Trig
lyce
rides
(mg/
dL)
Terri - HDL
Baseline 3-months 6-months40
42
44
46
48
50
52
54
56
58
Richard -- Before
Richard -- After
Richard – Weight Loss
Baseline 1 2 3 4200
220
240
260
280
300
320
340
Month
Body
Wei
ght (
lbs)
Richard – Body Fat
Baseline 1 2 3 40
5
10
15
20
25
30
35
40
45
Month
Body
Fat
(%)
The Newest PACE Program – PACE Express
• A fully-guided 6-DVD fitness program, with all the principles of PACE built in to each 12-minute workout
• No specialized equipment required
• Uses Progressive Muscle Sequencing
Progressive Muscle Sequencing
• Exercises rotate through all the large muscle groups
• This allows cardiopulmonary capacity to be reached prior to muscle failure
Dijon – Lost 119 Pounds of Fat
Elida -- Lost 27 Pounds of Fat
Ana – Lost 10 Pounds of Fat
Amanda – Lost 17 Pounds of Fat
PACE Palm Beach StudyWeight Loss
1 2 3 4 5 6170
175
180
185
Month
Wei
ght (
lbs)
PACE Palm Beach Study GroupBody Fat
1 2 3 4 5 623
24
25
26
27
28
29
30
31
32
33
Tota
l Bod
y Fa
t (%
)
Month
PACE Palm Beach Study GroupSystolic Blood Pressure
1 2 3 4 5 6116
117
118
119
120
121
122
Month
Syst
olic
Blo
od P
ress
ure
PACE Palm Beach Study GroupDiastolic Blood Pressure
1 2 3 4 5 673.5
73.7
73.9
74.1
74.3
74.5
74.7
74.9
75.1
75.3
75.5
Dia
stol
ic B
lood
Pre
ssur
e
Month
PACE Los Angeles StudyWeight Loss
Initial 6-Day February June September160
165
170
175
180
185
190
Wei
ght (
lbs)
Month
PACE Los Angeles StudyBody Fat
Initial February June September20
22
24
26
28
30
32
Month
Tota
l Bod
y Fa
t (%
)
PACE -- The Future
PACE -- The Future
• New, state-of-the-art facility currently under construction in South Florida
• Will contain a full exercise physiology research lab for research – our first goal is to answer the questions regarding exactly how the body stores energy.
• Will also host community and professional seminars.
Certification Program
• The PACE Certification Program will allow health and fitness professionals to become PACE-Certified Trainers.
• Elements of the Certification Program will include:• The science of PACE• Components of PACE (breathing, rest/recovery, hydration)• How to tailor PACE to all fitness levels