Are Your Lungs Dying?Reversing the Age-Related Loss of Heart

and Lung Capacity

Al Sears, MD

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Let’s look at what the “experts” are recommending:

• American Medical Association• Moderate intensity exercise for 30-minutes/day, at least 5

days/week

• American College of Sports Medicine• Moderate intensity exercise for 30-minutes/day, at least 5

days/week

• American Heart Association• Moderate intensity exercise for 30-minutes/day, at least 5

days/week

• National Institute of Health• “regular, moderate exercise”

What if Everything You Thought You Knew About

Exercise Was Wrong?

The “Big 3” Cause More Problems Than They Solve

1. Aerobics

2. Cardio

3. Weight training

These modern approaches to exercise don’t work.

The Advice from the “Experts” Take You Down the Wrong Path

Modern Exercise Advice won’t help you:

1) Build functional strength

2) Make your heart stronger

3) Improve lung capacity

INTENSITY VS. DURATION

• 8,896 recreational runners reported average exercise duration and intensity

• High-intensity exercise associated with:Lower blood pressureLower triglyceridesLower CHOL/HDL ratiosLower BMIsLower waist, hip, and chest circumferences

• Exercise duration had no effect on these parameters

Williams P. Relationships of heart disease risk factors to exercise quantity and intensity. Arch Intern Med. 1998;158(3):237-245.

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

Rel

ativ

e R

isk

of D

eath

(%

)

Exercise Intensity

Lee IM, Hsieh, CC, Paffenparger, RS Jr. Exercise intensity and longevity in men. The Harvard Alumni Health Study. JAMA. 1995;273(15):1179-1184

The Data are Clear...

Prestigious studies like the Framingham Heart Study and the

Harvard Health Study have demonstrated that exercise intensity – not duration – is predictive of health

and longevity

Are Your Lungs Dying?

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.

FEV1 Declines With Age

Age

FE

V1

(lite

rs)

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

VO

2max

(m

l/kg/

min

)

Age

Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005

Even Moderate Pulmonary Impairment Increases Risk of Death

Years Post Follow-Up

FEV (%)Quintile:

Rel

ati

ve

Ris

k o

f D

eath

(al

l ca

use

s)

Schunemann H, et al. Pulmonary function is a long-term predictor of mortality in the general population: 29-year follow-up of the Buffalo Health Study. Chest. 2000 Sep;118(3):656-64.

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

Incidence of Congestive Heart Failure According to Vital Capacity

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.

The Bottom Line

• Lung capacity decreases with age

• Decreased lung capacity increased risk of all-cause mortality and 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.

Kannel WB, Seidman JM, Fercho W, Castelli WP. Vital Capacity and Congestive Heart Failure. The Framingham Study. Circulation. 1974;49(6):1160-1166.

Some Good News...

It’s possible to reverse the age-related

loss of pulmonary function … if you

focus on exercise intensity

Pre- and Post-Intervention Pulmonary Function

VO

2pea

k (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.

Building Younger LungsM

ax O

2 U

pta

ke (

ml/

Kg

min

)

Age

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

But what is happening to our heart capacity?

Maximum HR Declines With Age

30 35 40 45 50 55 60 65 70 75140

145

150

155

160

165

170

175

180

185

190

Adapted from: Dean, W. Biological Aging Measurement. 1988

Max

HR

(B

PM

)

Age

Cardiac Output Declines With Age

20 - 30 30 - 40 40 - 50 50 - 60 60 - 70 70 - 80 80 - 903.5

4

4.5

5

5.5

6

6.5

7

Car

diac

Out

put (

L/m

in)

Age

Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.

Some More Good News...

It’s possible to reverse the age-related

loss of cardiac function … if you focus

on exercise intensity

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)

*Low-intensity: HR @ 80% of gas exchange threshold (GET)**High-intensity: (HR @ GET – HR @ peak exercise)(40%) + HR @ GET

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 Peak O2 Uptake During Exercise

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

Cha

nge

in e

ject

ion

frac

tion

(%)

*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.

Low-Intensity Exercise Reduces Cardiac Function

6-months 12-months

∆ R

est

to P

eak

LVE

F (

%)

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.

The Faustian Bargain of Fitness

To keep up with popular trends, you will increase cardiac endurance but lose the one thing that

will save you from a heart attack:

Cardiac Capacity

Do Humans Really Need Endurance Training?

Ancient man never had the need for long-duration, medium-intensity exertion. This is also true in

the animal kingdom.

Short bursts of high-intensity are the norm for both man and animals. This kind of exertion is natural for survival, i.e. – escaping from

predators, hunting, climbing

Your Heart Doesn’t Need Endurance Training

The heart was designed by nature to last a lifetime. It doesn’t need training to pump blood for 80 or even 90 years.

If you train for endurance, you only increase efficiency in the narrow range of medium-intensity output.

Endurance Training is a High-Risk Challenge

This kind of activity forces your body to make dangerous choices, via adaptive responses:

•Regulation of body temperature

•Metabolism of waste products

•Conservation of energy – forces the storage of energy to maintain supply for repeated duration challenges. This usually occurs

as the production and storage of body fat.

Sacrificing Your Ability to Survive a Deadly Heart Attack

• The energy you need to fuel endurance training wipes out your heart’s reserve capacity

• In a weakened state, your heart has no reserve energy to supply a sudden demand for more oxygen

• During times of stress, this inability to rapidly supply more oxygen results in a heart attack

Cardiac Reserve and Heart Failure

Maximal level

Car

diac

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

These Data Support the Need to Reclaim Native Fitness

High-intensity exertion – the kind practiced by our ancient ancestors – is the key to modern

cardiopulmonary health

Exercise Intensity and Metabolism

What Does Your Body Use for Fuel?

ACTIVITY LEVEL PROTEIN CARBS FAT

Resting 1 to 5% 35% 60%

Low intensity 5 – 8% 70% 15%

Moderate Intensity 2 to 5% 40% 55%

High Intensity 2% 95% 3%

Adapted from: McArdle W et al. Sports & Exercise Nutrition. New York, NY: Lippincott, Williams & Wilkins;1999

The German Secret to Olympic Gold

• Interval training was the first formalized style of high-intensity exertion used to train athletes in the 1930’s

• However...interval training is demanding and not suited for people who are deconditioned and/or grossly overweight

The Solution

P.A.C.EPROGRESSIVELY

ACCELERATING

CARDIOPULMONARY

EXERTION

The One Think Modern Exercise Lacks: 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 inflating a balloon: the best way to fill a balloon to capacity is by gradually adding more air during each inflation

• Similar to muscle hypertrophy training where muscle capacity is increased by progressively 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

Improving Your Response Time: Acceleration

• Training to increase the speed at which the heart and lungs respond to increases in demand

• 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 – 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

PACE Twin Study – Body Fat Loss

4 8 12 160

2

4

6

8

10

12

14

16

18

Traditional CardioPACE

Pou

nds

of F

at L

ost

Weeks Post-Training

PACE Twin Study – Change in Lean Body Mass

4 8 12 16

-2

0

2

4

6

8

10

Traditional CardioPACE

Weeks Post-Training

Cha

nge

in L

ean

Bod

y M

ass

(lbs)

PACE Case Study –T.L.

• 55 year-old female

• 250-lbs

• 50% body fat

• Elevated triglycerides

• Low HDL

T.L. – Body Fat (%)

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

25

30

35

40

45

50

55

Bod

y F

at (

%)

Months Post-Training

T.L. – TriglyceridesT

rigly

cerid

es (

mg/

dL)

T.L. – HDL H

DL

(mg/

dL)

PACE Case Study – M.P.

• 283-lb male

• 42% body fat

• Taking 11 prescription drugs to manage obesity-related conditions

M.P. – Body Fat (%)

Initial 2 12 140

5

10

15

20

25

30

35

40

45

Months post-training

Bod

y F

at (

%)

M.P. – Increase in Lean Body Mass

2 12 140

5

10

15

20

25

30

35

Months post-training

Cha

nge

in L

ean

Bod

y M

ass

(lbs)

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 Workout?

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

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

PACE is Safe, Effective and Non-Threatening

• Interval training requires high-performance and aggressive goals, which may not be realistic for the average person.

• In contrast, PACE is progressively challenging. This allows the individual to set goals based on their current level of conditioning. Over time, high-intensity exertion becomes possible

• PACE is not psychologically or emotionally threatening. Because you start at a level that is comfortable, even if all you can do is walk, the idea of exertion and exercise is non-threatening

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