FoundMyFitness

#090 How Exercise Prevents & Reverses Heart Aging | Benjamin Levine, M.D.

Tue May 28 2024

exerciseheart agingbed restcardiopulmonary symptomscardiovascular healthadvanced glycation end productsexercise intensityeffective exercise strategiescardiovascular benefitscardiorespiratory fitnessindividual response to exercisetraining and heart sizeendurance training and heart sizecardiovascular regulationblood pressurepreventing overtrainingheart rate zonesgender differences in exerciseexercise and calcium scoresatherosclerosis and exerciseexercise and atrial fibrillation

Description

This episode explores the impact of exercise on heart aging, the effects of bed rest on physical ability, cardiopulmonary symptoms in athletes post-COVID, optimal exercise for cardiovascular health, combining exercise with advanced glycation end product inhibitor, exercise intensity and cardiovascular health, effective exercise strategies, cardiovascular benefits of exercise, cardiorespiratory fitness as a vital sign, individual response to exercise, training and heart size, endurance training and heart size, exercise and cardiovascular regulation, exercise and blood pressure, preventing overtraining and optimizing performance, heart rate zones and training indicators, gender differences in exercise and cardiovascular performance, exercise and calcium scores, atherosclerosis and exercise, exercise and atrial fibrillation. The episode provides key insights into these topics and emphasizes the importance of exercise for maintaining cardiovascular health.

Insights

Dr. Benjamin Levine's research shows that with the right exercise protocol, people can reverse up to 20 years of heart aging.

Consistent exercise can stave off cardiac stiffening and heart shrinkage seen later in life.

Extreme exercise may pose risks such as coronary artery calcification and atrial fibrillation.

Three weeks of bedrest can produce a functional decline worse than 30 years of aging, affecting heart size and fitness negatively.

Cardiopulmonary symptoms are crucial for evaluating athletes post-COVID to prevent heart and lung injuries.

Bed rest models, like the Dallas Bed Rest and Training Studies, have been used in spaceflight research to study cardiac aging.

Regular exercise of four to five days a week over a lifetime is optimal for preserving cardiovascular health.

Heart aging starts to become noticeable in late middle age, around 50 to 65 years old.

Advanced glycation end products contribute to skin and heart stiffening with age, but inhibiting them alone did not show improvement in sedentary seniors.

Advanced Glycation and Product Inhibitor alone did not help sedentary humans, but when combined with training, it reduced vascular age in 70-year-olds.

Increasing vagus tone or neural activity in the parasympathetic nerve may be protective against sudden cardiac death.

Endurance training and strength training are important for maintaining function and prolonging the period before disability sets in.

Different individuals have varying preferences for exercise duration and intensity.

Mixing up different types of training is more effective than doing the same routine repeatedly for fitness improvement.

Brushing teeth and exercising are both essential for health maintenance.

VO2 max correlates with longevity, influenced by cardiac output and AVO2 difference.

Low cardiorespiratory fitness is associated with a higher risk of mortality compared to smoking.

Cardiorespiratory fitness should be considered a vital sign, similar to blood pressure and body weight.

Measuring fitness levels can help in setting goals for improvement beyond just lifespan

Non-responders to exercise may benefit from increasing training dose or intensity

Chapters

Summary

Transcript

Exercise and Heart Aging

00:00 - 07:54

Dr. Benjamin Levine's research shows that with the right exercise protocol, people can reverse up to 20 years of heart aging.
Consistent exercise can stave off cardiac stiffening and heart shrinkage seen later in life.
Extreme exercise may pose risks such as coronary artery calcification and atrial fibrillation.
Dr. Levine explores the balance between beneficial and risky physical activities for heart health.
Three weeks of bedrest can produce a functional decline worse than 30 years of aging, affecting heart size and fitness negatively.

Impact of Bed Rest on Physical Ability

07:30 - 15:27

Three weeks of bed rest had a more negative impact on physical ability than 30 years of aging.
Maximal oxygen uptake is a key marker of fitness and was significantly affected by bed rest.
Bed rest led to shrinking and atrophy of the heart and blood vessels, impacting circulation.
After bed rest, less fit individuals recovered faster in terms of fitness compared to fitter individuals.
Athletes who quickly resumed training after COVID quarantine had lower rates of long COVID symptoms.

Cardiopulmonary Symptoms and Heart Aging

14:57 - 22:31

Cardiopulmonary symptoms are crucial for evaluating athletes post-COVID to prevent heart and lung injuries.
Bed rest models, like the Dallas Bed Rest and Training Studies, have been used in spaceflight research to study cardiac aging.
Heart muscle mass can decrease with sedentary behavior but increase with physical training, showing adaptability and plasticity.
Elite master's athletes show better heart flexibility and stretchiness compared to sedentary older individuals, indicating the impact of exercise on cardiovascular health.

Optimal Exercise for Cardiovascular Health

22:15 - 29:58

Regular exercise of four to five days a week over a lifetime is optimal for preserving cardiovascular health.
Heart aging starts to become noticeable in late middle age, around 50 to 65 years old.
Training at the right intensity and duration can reverse the effects of sedentary aging on the heart structure.
Advanced glycation end products contribute to skin and heart stiffening with age, but inhibiting them alone did not show improvement in sedentary seniors.

Combining Exercise and Advanced Glycation End Product Inhibitor

29:38 - 37:00

Advanced Glycation and Product Inhibitor alone did not help sedentary humans, but when combined with training, it reduced vascular age in 70-year-olds.
People with type 2 diabetes are at higher risk of advanced glycation end products and vascular damage.
Cardiac aging can be reversed in late middle age through a combination of exercise training and breaking advanced glycation end products.
Hemoglobin A1c is a good marker of diabetic control over the last few months.
Exercise training improves endothelial function and alters autonomic control of circulation.

Exercise Intensity and Cardiovascular Health

36:32 - 44:21

Increasing vagus tone or neural activity in the parasympathetic nerve may be protective against sudden cardiac death.
Endurance training and strength training are important for maintaining function and prolonging the period before disability sets in.
Higher intensity exercise has advantages for improving maximal aerobic power, but moderate intensity exercise also has benefits and is lower risk.
Maintaining fitness reduces the consequences of intense activity, with higher fitness levels resulting in lower risks during high-intensity exercises.

Effective Exercise Strategies

44:01 - 51:10

Different individuals have varying preferences for exercise duration and intensity.
Mixing up different types of training is more effective than doing the same routine repeatedly for fitness improvement.
A recommended strategy for overall cardiovascular health includes a mix of long sessions, high-intensity sessions, moderate-intensity sessions, and strength training.
Training goals should be aligned with either health preservation or competitive performance to determine the appropriate workout regimen.
Exercise should be treated as an essential part of daily personal hygiene to maintain long-term fitness and health.

Cardiovascular Benefits of Exercise

50:40 - 58:39

Brushing teeth and exercising are both essential for health maintenance.
VO2 max correlates with longevity, influenced by cardiac output and AVO2 difference.
Elite athletes have a larger stroke volume, key for high aerobic power.
Exercise improves cardiac structure and function, preserving vascular health.
High aerobic power benefits mortality by preserving vascular structure, endothelial function, autonomic tone, and mitochondrial function.
Exercise may help manage cardiovascular diseases but does not completely protect against them.

Cardiorespiratory Fitness as a Vital Sign

58:30 - 1:05:53

Low cardiorespiratory fitness is associated with a higher risk of mortality compared to smoking.
Cardiorespiratory fitness should be considered a vital sign, similar to blood pressure and body weight.
Measuring cardiorespiratory fitness can serve as a good biomarker for overall health.
Changes in fitness levels over time can impact mortality rates.

Individual Response to Exercise

1:05:30 - 1:13:11

Measuring fitness levels can help in setting goals for improvement beyond just lifespan
Non-responders to exercise may benefit from increasing training dose or intensity
Mixing up exercise routines can prevent boredom and improve compliance with physical activity
Different types of exercises play different roles in improving and preserving fitness over a lifetime
Stroke volume is crucial for cardiorespiratory fitness, especially for competitive athletes

Training and Heart Size

1:12:43 - 1:20:49

Training can significantly increase heart size and fitness, but there may be limitations in achieving the same heart size as elite athletes.
The pericardium plays a crucial role in preserving ventricular interaction and may limit the extent to which the heart can grow through training.
Training during growth stages may be essential for maximizing heart size and athletic performance.
Endurance athletes tend to have bigger hearts that are eccentrically remodeled, while strength-trained athletes have thicker hearts with concentric hypertrophy.

Endurance Training and Heart Size

1:20:26 - 1:28:53

Endurance athletes have eccentrically remodeled hearts for increased stroke volume and cardiorespiratory fitness.
Rowers and skiers have the biggest hearts due to a combination of strength and endurance activities.
Classification of sports based on static vs. dynamic exercise is being revised to reflect varying endurance and strength requirements within sports.
Strength-trained athletes should incorporate some endurance training for overall health and performance benefits.
Including endurance training is important for cardiovascular health and enhancing performance in sports requiring repetitive bursts of strength activities.

Exercise and Cardiovascular Regulation

1:28:25 - 1:36:14

During exercise, the brain sends signals to blood vessels causing vasoconstriction, leading to increased blood pressure and heart rate.
The exercise pressor reflex involves central command and sympathetic activation in response to muscle contractions.
Heart rate regulation during dynamic exercise is influenced by energetic signals from skeletal muscles.
Patients with metabolic myopathies experience increased cardiac output during exercise due to a need for more oxygen delivery.
Different types of exercises like CrossFit combine strength and endurance components, impacting heart training differently.

Exercise and Blood Pressure

1:35:52 - 1:44:04

Isometric exercises like static holds can improve blood pressure by causing relaxation of blood vessels.
Dynamic exercise is traditionally considered best for improving blood pressure as it causes relaxation of blood vessels.
Sustained endurance activity is recommended to dilate blood vessels and reduce blood pressure.
Lifestyle modifications like reducing salt intake, alcohol consumption, and getting enough sleep are important for managing hypertension.
Behavioral modifications can help modify essential hypertension in its earlier stages.

Preventing Overtraining and Optimizing Performance

1:43:47 - 1:52:00

Athletes often fall into the trap of overtraining when they believe training harder is the solution to poor performance.
Proper recovery after high-intensity sessions is crucial to prevent overtraining and maximize workout benefits.
Monitoring resting heart rate can help athletes gauge their training intensity and adjust accordingly to avoid overtraining.
A structured approach using different training zones can help optimize performance and prevent burnout in athletes.

Heart Rate Zones and Training Indicators

1:51:41 - 1:59:57

Athletes like Kipchoge work with experts to determine critical power and pacing strategies for optimal performance.
Heart rate zones are crucial for different types of events, such as marathon, 10K, and 5K races.
Heart rate variability is influenced by factors like respiration, intrinsic rhythms, and external stimuli.
Measuring heart rate variability can be challenging due to various uncontrollable factors and technique dependency.
Using heart rate variability as a training indicator may not be reliable unless under highly controlled conditions.

Gender Differences in Exercise and Cardiovascular Performance

1:59:30 - 2:07:06

Testosterone plays a significant role in the physical differences between men and women in terms of muscle building, fat reduction, and cardiovascular performance.
Biological sex differences become more pronounced during puberty due to increased testosterone levels.
Pre-menopausal women have lower risk of cardiovascular disease due to estrogen and progesterone, but smoking can negate this protection.
Women's response to exercise is generally similar to men's, with some differences observed in heart size increase related to testosterone levels.
Hormone replacement therapy may offer cardiovascular benefits if started early in menopause transition, but timing is crucial to avoid increasing risks like breast cancer.

Exercise and Calcium Scores

2:06:45 - 2:15:01

Testosterone enhances the building of cardiac and skeletal muscle.
Extreme exercise is typically defined as more than 10 hours a week, leading to potential risks like coronary plaque calcium buildup.
Calcified blood vessels are less likely to cause heart attacks compared to non-calcified plaques.
Studies show that athletes tend to have more calcified plaques but lower mortality rates and risk of heart attacks.
Higher fitness levels can mitigate the negative impact of high calcium scores on cardiovascular health.

Atherosclerosis and Exercise

2:14:34 - 2:22:22

Higher fitness levels can mitigate the negative effects of high calcium scores on health.
Atherosclerosis is influenced by various risk factors including high cholesterol, hypertension, smoking, diabetes, and genetics.
Exercise may not remove plaque but can provide protection against cardiovascular issues and make non-calcified plaque more rupture resistant.
Intense exercise may be more protective against calcification compared to longer duration exercise.
Endurance athletes may experience sustained increases in parathyroid hormone leading to calcium leaching from bones.
Extreme endurance activities can increase the risk of atrial fibrillation due to changes in heart structure and function.
Moderate intensity physical activity for three to five hours is associated with the lowest risk of atrial fibrillation.

Exercise and Atrial Fibrillation

2:22:03 - 2:29:59

Recreational and occupational exercise does not significantly increase the risk of atrial fibrillation (AFib) or stroke.
Athletes, including endurance athletes, may have varying risks of AFib and stroke depending on individual factors.
Anticoagulation therapy can help reduce the risk of stroke in individuals with AFib but may pose a bleeding risk for athletes involved in high-risk activities like cycling.
Management of AFib in athletes depends on factors such as frequency of episodes and individual risk profiles.
Extreme endurance training at older ages may require unique genetic predispositions to avoid injury, but it is not guaranteed to prolong life expectancy.
Studies on the impact of extreme exercise on mortality have shown conflicting results, with some suggesting no increase in mortality for high levels of physical activity.

Episode Summary

2:29:32 - 2:31:46

Dr. Benjamin Levine shared valuable information on how exercise can prevent and reverse aspects of heart aging.
A guide on Omega 3 supplementation is available for understanding the benefits, proper dosing, and common concerns.
Consumer genetic tests can reveal insights into fitness traits like endurance levels, VO2 max, muscle abilities, and susceptibility to injuries.
Free genetic fitness reports are offered on the website foundmyfitness.com/genetics using raw genetic data from services like 23andMe or AncestryDNA.
The host can be found on social media platforms under the handle found my fit for additional insights exclusive to each platform.