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Dr. Al Sears

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.

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Dr. Al Sears

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  1. What’s Wrong With Cardio?How to keep your heart from weakening, your lungs from shrinking, and your metabolism from dying. Dr. Al Sears

  2. 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

  3. Contrary to Popular Belief “Cardio” Fails to : • Preserve pulmonary function • Decrease risk of death from cardiovascular disease • Reduce overall mortality • Recondition metabolism for achieving and maintaining optimal body composition

  4. Pulmonary Function

  5. Vital Capacity Declines With Age Mean Vital Capacity (dL) 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.

  6. FEV1 Declines With Age FEV1 (liters) Age Adapted from: Dean, W. Biological Aging Measurement. 1988

  7. VO2Max Declines With Age VO2max (ml/kg/min) Age Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005

  8. So, what does this all mean?

  9. 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

  10. Incidence of Congestive Heart Failure According to Vital Capacity Rate of CHF/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.

  11. Even Moderate Pulmonary Impairment Increases Risk of Death Relative Risk of Death (all causes) FEV1 (%)Quintile: Years Post Follow-Up Cook DG, Shaper AG. Breathlessness, lung function and the risk of heart attack. Eur Heart J. 1988 Nov;9(11):1215-22.

  12. The Age-Related Decline in Pulmonary Function Can Be Reversed with the Right Physical Challenge

  13. Pre- and Post-Intervention Pulmonary Function VO2peak (L/min) Training Type 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.

  14. Building Younger Lungs Max O2 Uptake (ml/Kg min) Age Adapted from: von Ardennne, M. Oxygen Multistep Therapy. Theime. 1990. p.31.

  15. 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.

  16. Cardiovascular Function

  17. High-Intensity Exercise Improves Cardiac Function – Study Design 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.

  18. High-Intensity Exercise Improves Stroke Volume at Rest P = 0.014 Change in stroke volume (ml) 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.

  19. High-Intensity Exercise Improves Peak O2 Uptake During Exercise Change in peak O2 uptake 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.

  20. High-Intensity Exercise Improves Ejection Fraction 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.

  21. “Cardio” Reduces Change in Ejection Fraction ∆ Rest to Peak LVEF (%) 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.

  22. Why Does “Cardio” Fail to Deliver on its Promise?

  23. 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.

  24. 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.

  25. 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

  26. Cardiac Reserve and Heart Failure Maximal level Cardiac Power Output* (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

  27. 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

  28. Exercise Intensity and MortalityHarvard Health Study Relative Risk of Death (%) 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

  29. Improvements in Other Age-Related Bio-markers

  30. 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.

  31. High-Intensity Exertion, But Not “Cardio”, Increases Growth Hormone P < 0.05 relative to baseline ∆ in growth hormone (micrograms/L) No significant change from baseline Felsing NE, Brasel JA, Cooper DM. Effect of low and high intensity exercise on circulating growth hormone in men. J ClinEndocrinolMetab. 1992 Jul;75(1):157-62.

  32. 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 ApplPhysiolOccup Physiol. 1993;66(4):366-71.

  33. High-Intensity Exertion Dramatically Improves Blood Flow

  34. High-Intensity Exercise Preserves Telomere Length Mean leukocyte telomere length (kb) R = 0.44 P < 0.01 VO2max (ml/kg/min) 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.

  35. Bottom Line: High-intensity exertion reverses aging “Cardio” does NOT!

  36. But Doctor, what does this have to do with me?

  37. The Solution P.A.C.E PROGRESSIVELY ACCELERATING CARDIOPULMONARY EXERTION

  38. 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

  39. 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

  40. PACE - a New Exercise Principle

  41. “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!!

  42. 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

  43. PACE Restores Youthful Energy Energy stored in muscle allows for IMMEDIATE access to the energy, along with a greater willingness to expend it!!

  44. 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.

  45. High-Intensity Exertion Burns 9-Times More Fat Than “Cardio” Change in ∑ of skin folds /energy spent (mm/MJ) 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.

  46. PACE – The Twin Study

  47. PACE Twin Study – Body Fat Loss Pounds of Fat Lost Weeks Post-Training

  48. PACE Twin Study – Change in Lean Body Mass Change in Lean Body Mass (lbs) Weeks Post-Training

  49. Terri

  50. PACE Case Study – Terri • 55 year-old female • 250-lbs • 50% body fat • Elevated triglycerides • Low HDL

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