Managing the Age-Related Loss of Pulmonary Function: Extending Life by

Expanding Lungs

Al Sears, MD

Framingham Heart Study

• Framingham researchers followed 5209 participants over 18 years

• Biggest finding: the risk of congestive heart failure rose as lung capacity fell

• 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

Are Your Lungs Dying?

32 37 42 47 52 57 62 67 72 7715

20

25

30

35

40

45

Men

Women

Age

Mea

n V

ital C

apac

ity (

dL)

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.

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

<4.54.5 - 5.15.2 - 5.7>5.7

Rat

e o

f C

HF

/100

0

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

5th4th3rd2nd1st

Years Post Follow-Up

FEV (%)Quintile:

Rel

ati

ve

Ris

k o

f D

eath

(al

l ca

use

s)

The Data are Clear

• Lung capacity decreases with age

• Decreased lung capacity increased risk of heart failure

• Even moderate, non-clinical decreases in lung capacity increase risk of death

• Lung capacity is a clear and powerful marker of aging.

Some Good News...

The age-related loss of pulmonary

function is manageable and

modifiable

Factors Influencing Lung Capacity

Non-Modifiable

• Age• Gender• Height

Modifiable

• Weight• Smoking status

• Exercise

Exercise for Lung Expansion

Cardiopulmonary exercise falls into 2 broad categories:

1. Low/moderate intensity, long-duration: traditional “cardio” exercises (i.e., aerobics classes, distance jogging). Participants told to keep HR between 70 – 80% of maximum for 30 – 60 minutes

2. High-intensity, short duration: short bursts of exercise, aiming for >80% of maximum heart rate. Interval training falls in this category

Does Intensity Matter?

With regard to reducing the overall risk of death, the current research unequivocally supports the superiority of high-intensity

exercise over low/moderate-intensity exercise

Pre- and Post-Intervention Pulmonary Function

RST ET Control2.85

2.9

2.95

3

3.05

3.1

3.15

3.2

3.25

3.3

Pre-intervention

Post-intervention

VO

2pea

k (L

/min

)

Exercise Group

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.

High-Intensity Exercise Reduces Risk of Cardiovascular Disease

None 1 - 2,099 2,100 - 4,199 4,200 - 8,399 >8,4000

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1P, trend = 0.042

Rel

ativ

e R

isk

for

CH

D

Energy Expenditure (kJ/week)

Exercise Intensity and MortalityHarvard Health Study

Low Moderate High0.840000000000001

0.860000000000001

0.880000000000001

0.900000000000001

0.920000000000001

0.940000000000001

0.960000000000001

0.980000000000001

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

Rel

ativ

e R

isk

of D

eath

(%

)

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

Average people

Max

O2 U

pta

ke (

ml/

Kg

min

)

Age

Adapted from: von Ardennne, M. Oxygen Multistep Therapy. Theime. 1990. p.31.

The Bottom Line

High-intensity, short-duration exercise is the best type of exercise for increasing lung

capacity and decreasing risk of death

The Challenge

How do we bring the benefits of high-intensity training to the average deconditioned patient at

an age-management clinic?

The Solution

P.A.C.E.Progressively

Accelerating

Cardiopulmonary

Exertion

Progressivity

• Progressivity

• Repeated changes in the same direction.

• Regular and consistent increases in the intensity of demands placed on cardiovascular system

Acceleration

• Acceleration

• Training for faster and faster responses

• Target heart rate will be reached more quickly

• Recovery to resting heart rate also happens more quickly

PACE – The Twin Study

Female Fraternal Twins• 18-years old

• 24.5% body fat

• 16-weeks of training

PACE Twin

• Decreased body fat by14.5%

• Gained 9-lbs lean muscle

“Cardio” Twin• Decreased body fat by 5%

• Lost 2-lbs lean muscle

Case Study – Terri L.

• 55 year-old female• 250-lbs• 50% body fat• Elevated triglycerides• Low HDL

Terri L – Body Fat (%)B

ody

Fat

(%

)

Months Post-Training

1 2 3 4 5 6 7 8 9 10 11 12 13 1420

25

30

35

40

45

50

55

Terri L – Triglycerides

Baseline 3-months 6-months150

170

190

210

230

250

270

Trig

lyce

rides

(m

g/dL

)

Terri L – HDL

Baseline 3-months 6-months40

42

44

46

48

50

52

54

56

58

HD

L (m

g/dL

)

Terri L – Before

Terri L – After

Sample PACE Log

Warm up:_______________

Exercise:_________________

Initial Sets

Set 1 Set 2 Set 3

Exertion Recovery Exertion Recovery Exertion Recovery

Additional (optional) Sets

Set 4 Set 5 Set 6

Exertion Recovery Exertion Recovery Exertion Recovery

What Makes a PACE Work Out?

• Running• Rowing• Swimming• Bicycling• Jumping rope• Calisthenics

• Stair stepping• Elliptical• Circuit training• Hindu squats• Kettle bells

PACE Trial

My Wellness Research Foundation is currently conducting a longitudinal study to examine the efficacy of the PACE program

PACE Trial – Study Design

• 20 men and women (18+) with > 26% body fat• PACE-style exercise program supervised by an ACE-certified

trainer• Variables assessed include:

• Weight• Body fat & lean muscle mass• Cholesterol• Glucose and insulin• Testosterone• CRP and homocysteine

• VO2max and pulmonary function