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"Based on a series of studies performed by our team over the past 5 years, this 'dose' of exercise has become my prescription for life," said senior author Dr. Benjamin Levine, Director of the Institute for Exercise and Professor of Internal Medicine at UT Southwestern. "I think people should be able to do this as part of their personal hygiene - just like brushing your teeth and taking a shower." UT Southwestern Medical Center Press Release (January 8, 2018)

Two Years of Exercise—Intervals, Moderate, and Strength—Restores Elasticity to Middle Aged Heart

They say it’s never too late to begin exercising. A study published January 8, 2018, in the journal Circulation, carves out the parameters in the case of the sedentary, aging heart. The kind of exercise and how long you wait matters. Put it off too long or don’t do enough and you may cement the effects of age and sedentary living.

Dr. Benjamin Levine and his team have been studying the role of exercise in reversing the damage done to the heart by age and sedentary living.

They have found left ventricular stiffening in middle aged men and women who don't exercise and aren't fit, leaving them with small, stiff chambers that can't pump oxygenated blood out into the body effectively.

On the other hand, they have found that the heart chambers in competitive masters-level athletes remain large and elastic, and that committed exercise over decades is enough for noncompetitive athletes to reap most of this benefit.

As a final point, their research program has shown substantial improvements in cardiac compliance in young individuals after a year of training, but surprisingly little change if the training is started after age 65.

The current study continues this line of inquiry, seeking to find out if exercise begun in late middle age (before age 65) can restore heart fitness and elasticity.

The Study

They began by analyzing the hearts of 53 inactive but healthy men and women, aged 45 to 64. Left ventricle stiffness was calculated and maximum oxygen uptake was measured.

The participants were then randomly divided into two groups. Half were introduced to a four-to-five-day a week supervised exercise program, in 30-minute sessions, plus warm-up and cool-down. The other half served as controls, doing yoga and balance training for the same number of days. After two years, their hearts and fitness were analyzed once again.

Having found in an earlier study that exercise two to three times a week was not enough, participants were coached to gradually build up to the four-to-five day regimen over a period of 10 months, followed by peak and then maintenance training periods.

The exercise regimen included three types of exercise, with each participant provided with an individualized plan. One of the weekly sessions was devoted to high intensity intervals with a  90% to 95% heart rate for 4 minutes, with 3 minutes of recovery, repeated four times.

One or two of the other sessions was longer with moderate intensity. Levine says this session was designed to be fun activities such as tennis, aerobic dance, walking, or biking. Finally, one or two sessions were strength training, using free weights or machines. These sessions focused on whole body functional and core strength to complement the endurance training.

They must’ve found the sweet spot because both compliance and results were quite good. (The control group showed no improvement.)

The study group showed an 18 percent improvement in maximum oxygen intake and a more than 25 percent improvement in elasticity of the left ventricular muscle of the heart. Dr. Levine compared the change in the heart to a stretchy, new rubber band versus one that has gotten stiff sitting in a drawer.

“The near maximum [heart rate] and repeated exposure to this intense stimulus are the likely drivers of the ventricular remodeling and resultant increase on Vo2max,” the researchers wrote in the Discussion portion of their report. Interestingly, the majority of the gain occurred during the progressive and peak phases of training, when training days and intensity continued to increase. “When training volume was maintained from month 10 to 24, the additional change in Vo2max was negligible.”

Resting heart rate was also reduced, dropping from 63 to 58, which the researchers say is associated with reductions in mortality, independent of fitness levels.

“Thus, 2 years of exercise training at a frequency of 4 to 5 days per week had considerable cardiovascular benefits and may improve longevity and prevent development of heart failure,” the researchers reported

Key Findings

“The key finding is that 2 years of exercise training performed for at least 30 minutes, 4 to 5 days a week, and including at least 1 high-intensity interval session per week…increased maximal oxygen uptake and decreases cardiac stiffness in previously sedentary but otherwise healthy middle-aged adults,” Levine et al wrote in Circulation. “This study also demonstrated that exercise training can be adhered to by middle-aged adults over a prolonged period, suggesting that this may be an effective strategy to mitigate the deleterious effects of sedentary aging on the heart….Participants in the exercise group maintained excellent compliance with the 2-year exercise intervention.”

The program design allowed participants to gradually adjust to the frequency of the training regimen. “In addition, by varying the duration, intensity, and type of training over the course of the week, the training was not onerous and was feasible with excellent adherence to prescribed sessions,” the researchers added.

Dr. Levine is so convinced of the long term appeal of the design that it has become his “prescription for life.”

"I think people should be able to do this as part of their personal hygiene - just like brushing your teeth and taking a shower," he opined in a UT Southwestern press release.

You can read the study online: http://circ.ahajournals.org/content/early/2018/01/03/CIRCULATIONAHA.117.030617

My Take

Dr. Levine and his team are to be commended for showing that exercise truly is medicine. The right dose will make your body and your mind function at a high level for a very long time. The key is to find an approach that you are willing to stick with for life. I have two suggestions that will help make that possible.

Varying training from day to day is a great idea, especially making the steady state days enjoyable. The problem comes with the 4 by 4 all-out intervals. As Arthur Jones grudgingly admitted, the only way most people are willing to train all-out is with someone there to urge them on—in Jones’ example it was his hob nail boot. With Levine’s prescription it was the exercise physiologists who met with the participants regularly. When they fade away so will the motivation to drive their heart up to 90-95% for 4 minutes, rest 3 minutes—and then do it three more times. Very few can be expected to do that for very long.

A variety of shorter all-out intervals is much more doable. For more details, see my Psychology of Intervals: http://www.cbass.com/psychologyintervaltraining.html

The other problem is training to maintain. Do that and you’re toast.

Progress drives motivation. Without progress motivation slowly dries up and goes away. Make improvement the aim of every high-intensity training session. Look for ways to improve. You can almost always find something you can do better. Train for success and try never to fail. Takes some practice but it can be done.

When you can no longer improve, change your routine and start over again. Plan, gain, change, and then plan again. See my Flow and Row (http://www.cbass.com/Flow.htm) and the section on motivation in my book Lean For Life: http://www.cbass.com/PROD03.HTM


 Competition is a great motivator--if your goals are reasonable. Here I’m making a new PR for 2500 meters on the Concept 2 rower.
 My motivation was a young woman who beat my best time at a competition in Denver, giving me reason to raise my sights.
 She inspired me to go for a new PR after returning home and move up in the world rankings.

Photo by Carol Bass

February 1, 2018

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