E.B. Writers of Dallas

Exercise improves quality of life.

Wayne Epperson, correspondent | PULSE Magazine -- A Dallas Morning News publication, February 2005

One-third of hospital admissions for congestive heart failure – the largest health care expenditure for people over the age of 65 – could be prevented if people made regular exercise training as much a part of their personal hygiene as showering or brushing their teeth, says a Dallas cardiologist and cardiovascular physiologist.

“If, as a society, we could figure out ways to make that exercise lifestyle change then our health care expenditures would drop and the vigor of our aging population would increase, as would people’s quality of life,” says Benjamin Levine, M.D.

Dr. Levine’s prognosis is based on extensive research into the capacity of the human heart to adapt to stress placed upon it during exercise training. His latest study concluded that lifelong exercise training prevents the atrophy and stiffening of the heart that is normally attributed to aging and is a condition that leads to heart failure.

The study was conducted at the Institute for Exercise and Environmental Medicine at Presbyterian Hospital and at the University of Texas Southwestern Medical Center where Dr. Levine is a professor of internal medicine. He is the director of the institute.

There were three subject groups involved in the research. One group was comprised of 12 healthy sedentary seniors (six women and six men) who did not exercise. Another was made up of 12 Masters athletes (six women and six men) who had each trained 25 to 30 miles a week for more than 25 years and were very competitive at the regional or national level. The third group included 14 young but sedentary control subjects (seven women and seven men).

“We did some very invasive as well as some non-invasive measurements. I am one of the few people in the world who actually puts a heart catheter in the heart for research purposes to measure how stiff the heart is,” Dr. Levine says.

He likened the compliance of the heart to a rubber band, which if stretched far enough will snap back with vigor. But as the rubber band gets old and dry it doesn’t stretch very well and it doesn’t snap back very well.

“In order to measure how flexible or compliant something is you’ve got to measure its pressure, how much distending force there is and how stretchable it is, how big it gets. We used this catheter to measure the pressure and we used echo-cardiograph to measure the (blood) volume.

“We put the subjects in a gravity box, which uses a vacuum to pool blood below the heart, sort of like artificial gravity and then gave them some salt water. We started the heart over a whole range of filling pressures and we found that sedentary seniors, compared to the healthy young people, had markedly smaller, atrophied and stiffer hearts, even though they were completely healthy,” Dr. Levine says.

The Masters athletes’ hearts were indistinguishable from those of the young, healthy control subjects. “They looked as if they were 25-year-old hearts,” he says.

For the elderly who experience congestive heart failure, the hearts of about one third of them beat normally. “The problem isn’t with the ability of the heart to squeeze, but the inability of it to relax and to fill with blood at a low pressure. So, lifelong exercise training has the capacity to prevent fully a third of hospital admissions for heart failure. And that’s pretty impressive,” he says.

Not everyone can train at the Masters level, so Dr. Levine and his associates developed a year-long training program for the sedentary test group to see how they would respond to exercise. They began with relatively easy walking two or three times a week for 20 to 30 minutes. Every two weeks, for a year, the people would walk a little bit farther, and the intensity of difficulty was varied.

One male participant in the exercise program did so well after a year he began training for the White Rock Marathon and finished second in his age group in the Chicago half-marathon last summer.

“We measured the compliance of the hearts of the formerly sedentary group after a year of training and it got better, but not nearly as good as the people who trained their whole lives. So, I think first of all, it’s never too late to start,” Dr. Levine says.