Are Your Lungs Dying? Reversing the Age-Related Loss of Heart and Lung Capacity Al Sears, MD Let’s look at what the “experts” are recommending: • American.
Download ReportTranscript Are Your Lungs Dying? Reversing the Age-Related Loss of Heart and Lung Capacity Al Sears, MD Let’s look at what the “experts” are recommending: • American.
Slide 1
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 2
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 3
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 4
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 5
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 6
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 7
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 8
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 9
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 10
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 11
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 12
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 13
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 14
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 15
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 16
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 17
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 18
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 19
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 20
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 21
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 22
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 23
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 24
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 25
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 26
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 27
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 28
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 29
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 30
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 31
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 32
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 33
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 34
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 35
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 36
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 37
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 38
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 39
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 40
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 41
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 42
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 43
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 44
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 45
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 46
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 47
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 48
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 49
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 50
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 51
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 52
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 53
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 54
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 2
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 3
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 4
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 5
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 6
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 7
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 8
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 9
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 10
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 11
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 12
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 13
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 14
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 15
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 16
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 17
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 18
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 19
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 20
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 21
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 22
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 23
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 24
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 25
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 26
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 27
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 28
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 29
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 30
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 31
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 32
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 33
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 34
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 35
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 36
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 37
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 38
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 39
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 40
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 41
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 42
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 43
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 44
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 45
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 46
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 47
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 48
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 49
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 50
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 51
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 52
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 53
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function
Slide 54
Are Your Lungs Dying?
Reversing the Age-Related Loss
of Heart and Lung Capacity
Al Sears, MD
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)
2)
Build functional strength
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 pressure
Lower triglycerides
Lower CHOL/HDL ratios
Lower BMIs
Lower 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 Mortality
Relative Risk of Death (%)
Harvard Health Study
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
Mean Vital Capacity (dL)
Are Your Lungs Dying?
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.
FEV1 (liters)
FEV1 Declines With Age
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
VO2Max Declines With Age
52
Males
Females
48
VO2max (ml/kg/min)
44
40
36
32
28
24
20
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
Age
Wilmore J & Costill D. Physiology of Sport and Exercise:3rd Edition. Campaign, IL: Human Kinetics. 2005
Relative Risk of Death (all causes)
Even Moderate Pulmonary Impairment Increases
Risk of Death
FEV (%)
Quintile:
Years Post Follow-Up
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
Rate of CHF/1000
Incidence of Congestive Heart Failure
According to Vital Capacity
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 allcause 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
VO2peak (L/min)
Pre- and Post-Intervention
Pulmonary Function
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.
Max O2 Uptake (ml/Kg min)
Building Younger Lungs
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
190
185
180
Max HR (BPM)
175
170
165
160
155
150
145
140
30
35
40
45
50
55
Age
Adapted from: Dean, W. Biological Aging Measurement. 1988
60
65
70
75
Cardiac Output Declines With Age
7
Cardiac Output (L/min)
6.5
6
5.5
5
4.5
4
3.5
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
70 - 80
Age
Brandfonbrener M, et al. Changes in cardiac output with age. Circulation. 1955 Oct;12(4):557-66.
80 - 90
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
*
Change in ejection fraction (%)
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.
∆ Rest to Peak LVEF (%)
Low-Intensity Exercise Reduces
Cardiac Function
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.
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 HighRisk 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
Cardiac Power Output* (w)
Maximal level
* 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 highintensity 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.E
PROGRESSIVELY
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 lifethreatening 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
“Cardio” Twin
• Decreased body fat by14.5%
• Decreased body fat by 5%
• Lost 2-lbs lean muscle
• Gained 9-lbs lean muscle
PACE Twin Study – Body Fat Loss
18
Pounds of Fat Lost
16
14
12
10
Traditional Cardio
PACE
8
6
4
2
0
4
8
12
Weeks Post-Training
16
PACE Twin Study –
Change in Lean Body Mass
Change in Lean Body Mass (lbs)
10
8
6
Traditional Cardio
PACE
4
2
0
4
8
12
-2
Weeks Post-Training
16
PACE Case Study –T.L.
• 55 year-old female
• 250-lbs
• 50% body fat
• Elevated triglycerides
• Low HDL
T.L. – Body Fat (%)
55
50
Body Fat (%)
45
40
35
30
25
20
1
2
3
4
5
6
7
8
9
Months Post-Training
10
11
12
13
14
Triglycerides (mg/dL)
T.L. – Triglycerides
HDL (mg/dL)
T.L. – HDL
PACE Case Study – M.P.
• 283-lb male
• 42% body fat
• Taking 11 prescription drugs to manage obesity-related
conditions
M.P. – Body Fat (%)
45
40
Body Fat (%)
35
30
25
20
15
10
5
0
Initial
2
12
Months post-training
14
M.P. – Increase in Lean Body Mass
Change in Lean Body Mass (lbs)
35
30
25
20
15
10
5
0
2
12
Months post-training
14
Sample PACE Log
Warm up:_______________
Exercise:_________________
Initial Sets
Set 1
Exertion
Recovery
Set 2
Exertion
Recovery
Set 3
Exertion
Recovery
Additional (optional) Sets
Set 4
Exertion
Recovery
Set 5
Exertion
Recovery
Set 6
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 NonThreatening
• 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 ACEcertified trainer
• Variables assessed include:
•
•
•
•
•
•
•
Weight
Body fat & lean muscle mass
Cholesterol
Glucose and insulin
Testosterone
CRP and homocysteine
VO2max and pulmonary function