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CVD Risk Factors

LIPIDS (mg/dl) Total Cholesterol > 200 LDL-Cholesterol > 130 HDL-Cholesterol < 40 TG >150. NONLIPID RISK FACTORS Modifiable Non modifiable. CVD Risk Factors. A.T.P. III. Modifiable Risk Factors Hypertension Obesity Diabetes Thrombogenic/ Haemostatic State Cigarette Smoking

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CVD Risk Factors

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  1. LIPIDS (mg/dl) Total Cholesterol > 200 LDL-Cholesterol > 130 HDL-Cholesterol < 40 TG >150 NONLIPID RISK FACTORS Modifiable Non modifiable CVD Risk Factors A.T.P. III

  2. Modifiable Risk Factors Hypertension Obesity Diabetes Thrombogenic/ Haemostatic State Cigarette Smoking Physical Inactivity Atherogenic Diet Non modifiable Risk Factors Age Male Sex Family History of Premature CHD Non-lipid Risk Factors Life-style factors A.T.P. III

  3. Reduction of CVD Risk Factors • Physical activity both prevents and helps treat many established atherosclerotic risk factors; • - Low HDL-Cholesterol concentrations • - Elevated Triglyceride concentrations • Insulin Resistance and Glucose Intolerance • Elevated Blood Pressure • - Obesity

  4. Physical Activity and Blood Lipids • A meta-analysis of 52 exercise training trials of > 12 weeks’ duration including 4700 subjects demonstrated: •  [HDL-C] 4.6% •  [TG] 3.7% •  [LDL-C] 5% Leon A.S. et al Circulation 2001

  5. Subjects: 200 men, age < 65 years, with sedentary attitudes Training: 60 sessions of aerobic training, 21 weeks (1-4 sessions/week) Exercise effect on blood lipids “Heritage” Study Couillard, ATVB 2001

  6. Physical Activity and Blood Pressure • 44 randomized control trials (2674 particpants) have studied the effect of training exercise on resting blood pressure Exercise may serve as the only therapy in middle hypertensive subjects Fagard RH. Med Sci Sports Exerc. 2001

  7. Physical Activity and Blood Pressure • Sedentary patients should be advised to take up modest levels of aerobic exercise on a regular basis (walking, jogging or swimming for 30–45 min for 3-4 times/week) • Isometric exercise such as heavy weight-lifting can have a pressure effect and should be avoided. • If hypertension is poorly controlled in severe hypertension, heavy physical exercise should be discouraged or postponed until appropriate drug treatment is effective. EHS-ECS Guide-Lines for the management of Hypertension. J. Hypertens. 2003

  8. Physical Activity and Obesity NHI and ACSM Evidence Statements • Increases Cardiorespiratoty Fitness indipendent of weight loss (A) • Indepentendly reduces CVD risk factors (A) • Improves insuline action and reduces insulin resistance (A) • Increased aerobic activity reduses blood pressure independently of weight loss (A) • If accompanied by weight loss affects favorably blood lipids (A) G.A Bray, C. Bouchard. Hand Book of Obesity, 2004

  9. Physical Activity and Endothelial function • Physical Activity may also (some hypothesis): • Enhance endothelial function by increasing the production of nitric oxide and prostacyclin • Reduce LDL oxidation • Decrease the atherogenic activity of Mononuclear Cells by affecting the production of cytokines • Decrease the number of atherosclerotic lesions by reducing heart rate and pulsatile stress • Decrease the accumulation of collagen in the artery wall A. Cherubini et al. Aging Clin. Exp. Res. 1998

  10. Physical Activity and Stroke • The Nurse’s Health Study (72.488 subjects) data have demonstrate that: • Physical Activity is associated with reduced Risk of Total and Ischemic Stroke in a dose-respond manner. • Physical Activity level had no significant relationship with Subaracnoid or Intracerebral Haemorrhage. • Similar energy expenditure from walking and vigorous exercise confer similar reduction in stroke risk. Frank B. et al. JAMA. 2000

  11. Physical Activity and Stroke Relative risk of Stroke, according to usual walking pace (Nurse’s study) Hu et al, JAMA 2000

  12. Physical Activity and CHD Relative risk of cardiovascular events in diabetic women of the Nurse’s Study according to physical activity level The age-adjusted RR of new cases of CVD, according to Average hours of vigorous activity per week were: Phys. act, hrs/week CVD, Rel. Risk: Hu et al, Ann Int Med 2001

  13. Physical Activity and Claudicatio • Physical Activity is an effective treatment for improving walking distance • According to a meta-analysis of 21 exercise programs: • average distance to pain onset increased 179% or 225m • average distance to maximal tolerated pain increased 122% or 397m Exercise and Physical Activity in the Prevention and treatment of Atheroslerotic Cardiovascular Disease. AHA. Circulation 2003

  14. Physical Activity in Elderly • People > 65 years constitute a growing portion of word population population . • Age represents an independent, non modifiable CVD risk factor. • Age is no contraindication to being more active. • In elderly physical activity could prevent CVD and morbidity and disability. • Aerobic activities with low impact in muscoskeletal system and joints (brisk walking, swimming, cycling…) Cherubini A. et al. Aging Clin Exp Res. 1998

  15. Walking Compared with Vigorous Exercise for the Prevention of Cardiovascular Events in Women JoAnn E. Manson N Engl J Med 2002

  16. Aerobic exercise training reduces plasma endothelin-1 concentration in older women Seiji Maeda J Appl Physiol 2003

  17. Prevalenza della sedentarietà in anziani americani BRFSS, 2001 % Età CDC, 2001

  18. Percentuale di soggetti non istituzionalizzati con regolare attivita` di resistenza 3 volte o piu` alla settimana, secondo dati del NHIS 30 % soggetti attivi 20 10% 8% 7.8% 10 5% 0 18-29 30-44 45-64 > 65 Gruppi di eta` Caspersen et al., 1988

  19. Percentuale di soggetti ultra-sessantacinquenni che seguono le raccomandazioni dell’ NHIS per l’attività fisica in relazione a diverse caratteristiche della popolazione (n=5537) Sesso Donne Uomini BMI > 30 < 25 Salute Scadente Eccellente Scolarità Elementare Universitaria percentuale CDC, 2001

  20. Modificazioni della composizione corporea associate all` invecchiamento  peso corporeo  altezza  grasso corporeo con ridistribuzione centrale dell‘adipe  massa muscolare

  21. Modificazioni della composizione corporea e della distribuzione del grasso corporeo dopo esercizio di resistenza  %grasso corporeo totale e della massa grassa  WHR e del tessuto adiposo viscerale valutato con TAC  FFM a livello della coscia W. M. Kohrt et al.,1992

  22. Modificazioni muscolari legate all`invecchiamento  forza muscolare  massa muscolare totale  numero e dimensione fibre tipo II  unita` motorie processi neuropatici  numero e dimensione mitocondri  attivita` enzimi ossidativi Fiatarone M. A. et al.,1993

  23. Aging and sarcopenia • Timothy J. Doherty J Appl Physiol 2003

  24. Relazione tra livello di attività fisica e markers infiammatori The MacArthur Studies of Successfull Aging Terzile Superiore PCR† Terzile Superiore IL-6* OR (95% IC) Livello di attività fisica Alto livello attività fisica di svago 0.65 (0.48-0.87)0.70(0.51-0.95) Alto livello di attività fisica in casa/giardino 0.90(0.67-1.20) 0.70(0.51-0.96) Alto livello di attività fisica Durante il lavoro 1.02(0.76-1.38) 0.99(0.68-1.30) * dopo aggiustamento per BMI, scolarità, storia di cardiopatia ischemica † dopo aggiustamento per BMI, scolarità, razza, fumo, storia di cardiopatia ischemica Reuben DB, 2003

  25. Relazione tra modificazioni della VO2 max con l‘invecchiamento e stato funzionale 40 Camminare per qualche isolato 20 VO2 max (ml/Kg-1/min -1) Camminare in casa 10 0 Sarcopenico malato Sarcopenico sano Adulto 80% of VO2 max: occurrence of dyspnea Roubenoff, 1999

  26. Modificazioni della VO2 max legate all`età e all`attività fisica 70 VO2 max (ml/Kg-1/min -1) 50 30 intervento dell`attività fisica Attivi Sedentari 10 20 40 60 80 Eta´ Buskirk et al., 1987

  27. Variazioni di peso e composizione corporea dopo 20 settimane diesercizio di resistenza pre - training post - training * Kg % 80 80 * 60 60 *P<0.05 40 40 * * 20 20 0 0 %FAT PESO FFM FAT MASS J. H. Wilmore et al., 1999

  28. Variazioni del tessuto adiposo e della sua distribuzione dopo 20 settimane di esercizio di resistenza * cm2 pre - training post - training cm 300 * * *P<0.05 * 100 200 100 * 50 * 1 0 viscerale totale sottocutaneo Circ. vita Circ. fianchi WHR Grasso addominale J. H. Wilmore et al., 1999

  29. Esercizio di resistenza e dispendio energetico basale 12 settimane di esercizio di resistenza 8 maschi 4 femmine 56-80 anni BMI 26+0.6  MASSA MAGRA  MASSA GRASSA  RMR (6.8%) = RMR DOPO PAREGGIAMENTO PER FFM W. W. Campbell et al., 1994

  30. Can physical activity attenuate aging-related weight loss in older people? The Yale Health and Aging Study, 1982-1994.Dziura, Am J Epidemiol 2004

  31. Modificazioni della forza muscolare dopo esercizio di potenza Post-training Pre-training Exercise Knee flexion 0.22 + 0.02 0.40 + 0.04* Right knee extension 0.27 + 0.03 0.42 + 0.03* Left knee extension 0.26 + 0.03 0.41 + 0.03* kg/kg FFM *p<0.001 Campbell et al., 1994

  32. Relazione tra intensita` dell`esercizio e risposta fisiologica nell`anziano Variazioni forza quadricipite (%) 175 150 100 50 0 Low Moderate High Training intensity M. A. Fiatarone et al., 1993 (mod)

  33. Effetti dell’esercizio su forza muscolare e composizione corporea Aniasson, 1981 3-mesi Bassa intensità No modificazioni area Trasversale muscolare  Forza muscolare Uomini sani (69-74 anni) 6-mesi Alta intensità Uomini sani (64 anni) Frontera, 1988 • 11% area trasversale metà coscia •  Forza muscolare Pratley, 1994 Uomini sani (50-65 anni) 4-mesi Alta intensità  FFM, FM  40% forza muscolare Pyka, 1994 area trasversale fibre muscolari  forza muscolare Uomini sani (68 anni) 7 mesi Alta intesità Fiatarone, 1990 (72-98 anni)  • 2.7% area trasversale metà coscia  113% forza muscolare 2 mesi Alta intensità Uomini e donne fragili istituzionalizzati Fiatarone, 1994  9% area trasversale metà coscia  174% forza muscolare (età media 90 anni)  Mod from Bross, 1999

  34. Probabilità di morire in età avanzata, senza disabilità nell’anno antecedente la morte in relazione al livello di attività fisica EPESE Study % di 65 enni sopravvissuti fino a 80 anni (uomini) o 85 anni (donne) % of 65 enni sopravvissuti fino a 80 e 85 anni senza disabilità % di anziani deceduti in età avanzata senza disabilità Uomini Low exercise 34 43 15 Medium exercise 48 45 22 High exercise 63 58 37 Donne Low exercise 47 22 10 Medium exercise 57 34 19 High exercise 70 41 29 Leveille et al. Am J Epidemiol 1999;149:654-664.

  35. a 60 50 40 % disability 30 BMI >= 25 (n=63) 20 b 10 BMI < 25 (n=22) 0 1st 2nd 3rd (0-420) (421-728) (729-2300) tertiles of physical exercise (min/week) Leisure time physical activity obesity and disability in the Elderly Di Francesco, Aging in press

  36. Bull World Health Organ vol.81 no.11 Genebra Nov. 2003 POLICY AND PRATICE Exercise interventions: defusing the world's osteoporosis time bomb Kai Ming ChanI, 1; Mary AndersonII; Edith M.C. LauIII ... Walking, aerobic exercise, and t'ai chi are the best forms of exercise to stimulate bone formation and strengthen the muscles that help support bones. ... Encouraging physical activity at all ages is therefore a top priority to prevent osteoporosis

  37. It is clear that exercise late in life, even beyond 90 years of age, can increase muscle mass and strength twofold or more in frail individuals ...there is convincing evidence that exercise in elderly persons also improves function and delays loss of independence and thus contributes to quality of life... ... randomized clinical trials of exercise have been shown to reduce the risk of falls by approximately 25 percent

  38. Fitness cardio-vascolare • Performance cardiaca • Picco di riempimento diastolico • Contrattilità cardiaca  Contrazioni ventricolari premature  Capacità aerobica • PA sistolica e diastolica Miglioramento profilo lipidico ematico Miglioramento resistenza • Sistema • Muscolo-scheletrico •  Forza, flessibilità • Disabilità muscoloscheletrica • Rischio cadute • Rischio fratture • Tempi di reazione • Peso • Corporeo • Tessuto adiposo viscerale • Grasso corporeo percentuale • Massa muscolare Benefici legati all’attività fisica • Benessere • psico-fisico • livelli catecolamine, norepinefrina e serotonina • Depressione • Osteoporosi • declino densità ossea  densità ossea • Diabete • tipo 2 • Tolleranza glucidica • HDL • LDL e VLDL • Trigliceridi National Blueprint, 2001 The RobertWood Johnson Foundation

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