Mayo Clinic Division of Preventive Cardiology will be preparing a series of recordings focusing on Cardiovascular Disease states. This is the Exercise Series and this particular one focuses on exercise and the heart.
In walking 100 laps of his garden, the Second World War veteran set out to raise £1,000 for NHS charities; instead, on his 100th birthday, his appeal topped £32 million. The journey continued, not in his garden, but on talk shows, breakfast television and interviews, all for the benefit of causes that touched his own life across the century. Here, the GQ Inspiration Award recipient shows us just how he got in shape…
Captain Sir Thomas Moore, popularly known as “Captain Tom”, is a former British Army officer and centenarian, known for his achievements raising money for charity in the run-up to his 100th birthday during the COVID-19 pandemic.
Many studies suggest that exercise can help protect our memory as we age. This is because exercise has been shown to prevent the loss of total brain volume (which can lead to lower cognitive function), as well as preventing shrinkage in specific brain regions associated with memory. For example, one magnetic resonance imaging (MRI) scan study revealed that in older adults, six months of exercise training increases brain volume.
Another study showed that shrinkage of the hippocampus (a brain region essential for learning and memory) in older people can be reversed by regular walking. This change was accompanied by improved memory function and an increase of the protein brain-derived neutropic factor (BDNF) in the bloodstream.
The brain is highly dependent on blood flow, receiving approximately 15% of the body’s entire supply – despite being only 2-3% of our body’s total mass. This is because our nervous tissues need a constant supply of oxygen to function and survive. When neurons become more active, blood flow in the region where these neurons are located increases to meet demand. As such, maintaining a healthy brain depends on maintaining a healthy network of blood vessels.
Regular exercise increases the growth of new blood vessels in the brain regions where neurogenesis occurs, providing the increased blood supply that supports the development of these new neurons. Exercise also improves the health and function of existing blood vessels, ensuring that brain tissue consistently receives adequate blood supply to meet its needs and preserve its function.
Recently, a growing body of research has centred on microglia, which are the resident immune cells of the brain. Their main function is to constantly check the brain for potential threats from microbes or dying or damaged cells, and to clear any damage they find.
With age, normal immune function declines and chronic, low-level inflammation occurs in body organs, including the brain, where it increases risk of neurodegenerative disease, such as Alzheimer’s disease. As we age, microglia become less efficient at clearing damage, and less able to prevent disease and inflammation. This means neuroinflammation can progress, impairing brain functions – including memory.
Exercise training is a safe, effective and low-cost intervention for improving walking ability in patients with IC. Additional benefits may include improvements in QoL, muscle strength and cardiorespiratory fitness. Clinical guidelines advocate supervised exercise training as a primary therapy for IC, with walking as the primary modality.
However, evidence is emerging for the role of various other modes of exercise including cycling and progressive resistance training to supplement walking training. In addition, there is emerging evidence for home-based exercise programmes. Revascularisation or drug treatment options should only be considered in patients if exercise training provides insufficient symptomatic relief.
Peripheral artery disease (PAD) is caused by atherosclerotic narrowing of the arteries supplying the lower limbs often resulting in intermittent claudication, evident as pain or cramping while walking. Supervised exercise training elicits clinically meaningful benefits in walking ability and quality of life. Walking is the modality of exercise with the strongest evidence and is recommended in several national and international guidelines. Alternate forms of exercise such as upper- or lower-body cycling may be used, if required by certain patients, although there is less evidence for these types of programmes. The evidence for progressive resistance training is growing and patients can also engage in strength-based training alongside a walking programme. For those unable to attend a supervised class (strongest evidence), home-based or ‘self-facilitated’ exercise programmes are known to improve walking distance when compared to simple advice. All exercise programmes, independent of the mode of delivery, should be progressive and individually prescribed where possible, considering disease severity, comorbidities and initial exercise capacity. All patients should aim to accumulate at least 30 min of aerobic activity, at least three times a week, for at least 3 months, ideally in the form of walking exercise to near-maximal claudication pain.
There are over 35,000,000 reported cases of COVID-19 disease and 1 000 000 deaths across more than 200 countries worldwide.1 With cases continuing to rise and a robust vaccine not yet available for safe and widespread delivery, lifestyle adaptations will be needed for the foreseeable future. As we try to contain the spread of the virus, adults are spending more time at home. Recent evidence2 suggests that physical activity levels have decreased by ~30% and sitting time has increased by ~30%. This is a major concern as physical inactivity and sedentary behaviour are risk factors3 for cardiovascular disease, obesity, cancer, diabetes, hypertension, bone and joint disease, depression and premature death.
To date, more than 130 authors from across the world have provided COVID-19-related commentary on these concerns. Many experts4 have emphasised the importance of increasing healthy living behaviours and others5 have indicated that we are now simultaneously fighting not one but two pandemics (ie, COVID-19, physical inactivity). Physical inactivity alone results in over 3 million deaths per year5 and a global burden of US$50 billion.6 Immediate action is required to facilitate physical activity during the COVID-19 pandemic because it is an effective form of medicine3 to promote good health, prevent disease and bolster immune function. Accordingly, widespread messaging to keep adults physically active is of paramount importance.
Several organisations including the WHO, American Heart Association and American College of Sports Medicine have offered initial suggestions and resources for engaging in physical activity during the COVID-19 pandemic. Expanding on these resources, our infographic aims to present a comprehensive illustration for promoting daily physical activity to the lay audience during the COVID-19 pandemic (figure 1). As illustrated, adults are spending more time at home, moving less and sitting more. Physical activity provides numerous health benefits, some of which may even help directly combat the effects of COVID-19. For substantial health benefits, adults should engage in 150–300 min of moderate-to-vigorous intensity physical activity each week and limit the time spent sitting. The recommended levels of physical activity are safely attainable even at home. Using a combination of both formal and informal activities, 150 min can be reached during the week with frequent sessions of physical activity spread throughout the day. Sedentary behaviour can be further reduced by breaking up prolonged sitting with short active breaks. In summary, this infographic offers as an evidence-based tool for public health officials, clinicians, educators and policymakers to communicate the importance of engaging in physical activity during the COVID-19 pandemic.
HARVARD MAGAZINE (SEPT – OCT 2020): From the book EXERCISED: Why Something We Never Evolved to Do Is Healthy and Rewarding by Daniel E. Lieberman, to be published on September 8, 2020 by Pantheon Books:
‘….many of the mechanisms that slow aging and extend life are turned on by physical activity, especially as we get older. Human health and longevity are thus extended both by and for physical activity.’
Exercise is like scrubbing the kitchen floor so well after a spill that the whole floor ends up being cleaner. The modest stresses caused by exercise trigger a reparative response yielding a general benefit.
In order to elucidate the links between exercise and aging, I propose a corollary to the Grandmother Hypothesis, which I call the Active Grandparent Hypothesis. According to this idea, human longevity was not only selected for but was also made possible by having to work hard during old age to help as many children, grandchildren, and other younger relatives as possible survive and thrive. That is, while there may have been selection for genes (as yet unidentified) that help humans live past the age of 50, there was also selection for genes that repair and maintain our bodies when we are physically active.
Daniel E. Lieberman is a paleoanthropologist at Harvard University, where he is the Edwin M Lerner II Professor of Biological Sciences, and Professor in the Department of Human Evolutionary Biology. He is best known for his research on the evolution of the human head and the evolution of the human body.
Contributing correspondent Kai Kupferschmidt talks with host Sarah Crespi about the success of a fast moving megatrial for coronavirus treatments. The United Kingdom’s Recovery (Randomized Evaluation of COVID-19 Therapy) trial has enrolled more than 12,000 hospitalized coronavirus patients since early March and has released important recommendations that were quickly taken up by doctors and scientists around the world.
Kupferschmidt discusses why such a large study is necessary and why other large drug trials like the World Health Organization’s Solidarity trial are lagging behind. Also this week, producer Meagan Cantwell talks with Saul Villeda, a professor in the Department of Anatomy at the University of California, San Francisco, about transferring the beneficial effects of exercise on the brain from an active mouse to a sedentary mouse by transferring their blood.
From The Lancet Diabetes & Endocrinology (June 2020):
Our findings show that the intensive lifestyle intervention led to significant weight loss at 12 months, and was associated with diabetes remission in over 60% of participants and normoglycaemia in over 30% of participants. The provision of this lifestyle intervention could allow a large proportion of young individuals with early diabetes to achieve improvements in key cardiometabolic outcomes, with potential long-term benefits for health and wellbeing.