30
SIMPeSS HPMS Spoleto 11-12 giugno 2004 Salute e longevità Prof. Roberto Bernabei - U. C. S. C. Roma
SIMPeSSHPMS
Spoleto 11-12 giugno 2004
Salute e longevità
Prof. Roberto Bernabei - U. C. S. C. Roma
"THE DEMOGRAPHIC TIMEBOMB"
14
16
18
20
22
24
26
28
30
1995 2000 2005 2010 2015 2020
Anni
% t
otal
e po
pola
zion
e
ItaliaBelgioGermaniaGreciaSveziaFranciaGran BretagnaOlandaIrlanda
ITALIA:POPOLAZIONE O-19 e >65
0%
15%
30%
45%
60%
1950 1975 2000 2025 2050
% P 0 - 19% P 65 +
Presidenza del Consiglio 2001
La piramide familiare nel Nord Italia
Bisnonni
Nonni
Genitori
Figli
If exercise could be packedIf exercise could be packedinto a pill, it would be theinto a pill, it would be the
single most widelysingle most widelyprescribed, and beneficial,prescribed, and beneficial,
medicine in the nation.medicine in the nation.
Robert N. Butler, M.D.
National Institute on Aging
Trial clinici sui benefici dell’attività fisica
Physiology: (12 RCT’s, 1230 persons)↑ VO2 peak, ↑ bone density, ↑ lipid profile, ↑ heart rate variability, ↑ vasodilatation, ↓ heart rate
Functional impairments: (10 RCT’s, 1150 persons)↑ muscle strength, ↑ reaction time, ↑ balance
Physical performance: (8 RCT’s, 900 persons)↑ walking speed, ↑ chair rise, ↑ stair climbing speed
A prospective study of walking as compared with vigorous exercisA prospective study of walking as compared with vigorous exercise in the e in the prevention of coronary heart disease in women.prevention of coronary heart disease in women.
BACKGROUND: The role of walking, as compared with vigorous exercise, in the prevention of coronary heart disease remains controversial, and data for women on this topic are sparse. METHODS: We prospectively examined the associations between the score for total physical activity, walking, and vigorous exercise and the incidence of coronary events among 72,488 female nurses who were 40 to 65 years old in 1986. Participants were free of diagnosed cardiovascular disease or cancer at the time of entry and completed serial detailed questionnaires about physical activity. During eight years of follow-up, we documented 645 incident coronary events (nonfatal myocardial infarction or death from coronary disease). RESULTS: There was a strong, graded inverse association between physical activity and the risk of coronary events. As compared with women in the lowest quintile group for energy expenditure (expressed as the metabolic-equivalent [MET] score), women in increasing quintile groups had age-adjusted relative risks of 0.77, 0.65, 0.54, and 0.46 for coronary events (P for trend <0.001). In multivariate analyses, the inverse gradient remained strong (relative risks, 0.88, 0.81, 0.74, and 0.66 for women in increasing quintile groups as compared with those in the lowest quintile group; P for trend=0.002). Walking was inversely associatedwith the risk of coronary events; women in the highest quintile group for walking, who walked the equivalent of three or more hours per week at a brisk pace, had a multivariate relative risk of 0.65 (95 percent confidence interval, 0.47 to 0.91) as compared with women who walked infrequently. Regular vigorous exercise (> or =6 MET) was associated with similar risk reductions (30 to 40 percent). Sedentary women who became active in middle adulthood or later had a lower risk of coronary events than their counterparts who remained sedentary. CONCLUSIONS: These prospective data indicate that brisk walking and vigorous exercise are associated with substantial and similar reductions in the incidence of coronary events among women. N Engl J Med 2002
N Engl J Med, 2002; 347: 716-25
Effetto dell’attività fisica moderata sulla sopravvivenza nei soggetti anziani
0,6
0,7
0,8
0,9
1,0
0 1 2 3 4 5 6 7 8 9 10 11 12
Età >80 anni
0,6
0,7
0,8
0,9
1,0
0 1 2 3 4 5 6 7 8 9 10 11 12
Età < 70 anni
Sopr
avvi
venz
a
Mesi
0,6
0,7
0,8
0,9
1,0
0 1 2 3 4 5 6 7 8 9 10 11 12
Età 70-80 anni
Sopr
avvi
venz
a
Mesi
Sopr
avvi
venz
a
Mesi
Attivi Attivi
Attivi
SedentariSedentari
Sedentari
Landi F et al, Aging Clin Exp Res 2002
Jack LaLanne, 87 anni
Il padre del Fitness ha iniziato la sua attivitàsportiva nel 1936.
Oggi il suo allenamentoprevede un’ora dipalestra ed un’ora dinuoto ogni giorno!
75 anniRecord del mondomaratona, 3h 30’
70 anniRecord del mondomaratona, 3h 03’
Long-term calorie restriction is highly effective in reducing the risk for atherosclerosis in humans.
Fontana L et al, PNAS 2004
0 1000 2000 3000 40000.0
0.8
Sopr
avvi
venz
a (%
)0.6
0.4
0.2
1.00.9
0.7
0.5
0.3
0.1
Score 3Score 2Score 1Score 0
0 1000 2000 3000 40000.0
0.8
Sopr
avvi
venz
a (%
)
Giorni
0.6
0.4
0.2
1.00.9
0.7
0.5
0.3
0.1
Score 3Score 2Score 1Score 0
Sopravvivenza in 1.281 europei di età 70-75 in base ad attività fisica, dieta e astensione dal fumo (score 3= stile di vita ottimale; score 0= stile di vita peggiore).
Haveman-Nies A et al, Am J Med 2002
Mortalità a 30 giorni e ad un anno dal ricovero per IMA in 132 130 anziani seguiti dal MEDICARE (1 reddito minore, 10 reddito maggiore).
Haveman-Nies A et al, Am J Med 2002
Dose-Related Impact of Alcohol Consumption onCognitive Function in Advanced Age: Results of aMulticenter Survey.
Non bevitori < 0.5 L 0.5-1 L > 1.0 L
Odd
sRa
tio
0.5
1.0
1.5
2.0
2.5
Zuccala G et al, Alcohol Clin Exp Res 2001
Landi F et al. Aging Clin Exp Res 2003
Mortalità globale in rapporto ai livelli plasmatici di IL-6 in 525 anziani “sani” arruolati nello studio di Framingham
Roubenoff R et al, Am J Med 2003
Tipo di esame A partire da Frequenza
Esplorazione rettale e PSASangue occulto nelle feciColonscopiaECGTSHColesterolemiaPressione arteriosa
50 anni50 anni50 anni50 anni60 anni50 anni50 anni
Ogni annoOgni annoOgni 10 anniOgni annoOgni annoOgni annoDue volte l’anno
♂
Tipo di esame A partire da Frequenza
MammografiaSangue occulto nelle feciColonscopiaPAP testECGTSHColesterolemiaPressione arteriosa
40 anni50 anni50 anni20 anni50 anni60 anni50 anni50 anni
Ogni annoOgni annoOgni 10 anniOgni anno fino ai 70 anniOgni annoOgni annoOgni annoDue volte l’anno
♀
IL MITO ETERNO DELL’ETERNA GIOVINEZZA
A proposito di elisir…Silvio tecnicamente è quasi immortale
Parla il professor Umberto Scapagnini, medico e sindaco:• «Ha l’attività mentale e sessuale di un cinquantenne»
«Silvio tecnicamente è quasi immortale. Con il mio elisir ha 12 anni di meno»
• «Provitamine, antiossidanti, immunostimolanti, enzimi, amminoacidi, e soprattutto minerali, magnesio e selenio attivato. Gli stessi che assorbono i centenari che ho incontrato sulla via della Seta, a Sud di Urumqi e nelle oasi tra il deserto del Taklamakhan e il Gobi. Poi un olio particolare, un certo yogurt»
• «Il criterio è rigorosamente scientifico. C'è un metodo per calcolare la differenza tra l'età anagrafica e l'età biologica, tra i dati teorici e l'effettiva attività mentale, fisica, sessuale». Scapagnini a esempio ha 62 anni, non li dimostra e in effetti ne ha 11 di meno.«Berlusconi è meglio: meno 12». Il record appartiene a MikeBongiorno: meno 17. Ma si può migliorare…
Aldo Cazzullo, 3 febbraio 2004
THE ANTIOXIDANT PARADOX
• People with diets rich in fruit and vegetables have a decreased chance of getting cancer and an increase in the concentration of beta-carotene in the blood. Supplements of beta-carotene, however, do not have an anti-cancer effect, rather the opposite in smokers.
• Fruit and vegetable consumption decreases the amount of free-radical damage to DNA in the human body (a risk factor for cancer development), but supplements of ascorbate, vitamin E, or beta-carotene do not decrease DNA damage in most studies.
• Vitamin-E supplements were not protective againstcardiovascular disease in the GISSI-Prevenzione trial.
Halliwell B, Lancet 2000
Mortalità globale in 25 563 soggetti arruolati nel trial ATBC (supplementazione di alfa-tocoferolo e beta-carotene in maschi fumatori)
ATBC Study Group. JAMA 2003.
Can Aging Be Reversed?As you grow older the process of aging exacts a startling toll - decreased energy and hormonal levels; increased sags, wrinkles, and skin spots; reduced muscle and bone mass; declining mental alertness and acuity; thinning or loss of hair; decreased visual power and perception ... all these ways your body devolves from the pristine state of its youth to the ramshackle state of its elderly years.
HGH Levels Decrease With AgeStrangely, and perhaps not coincidentally, the aging process is accompanied by a dramatic decrease in the body's overall hormonal output. Of the many hormones produced by your endocrine (glandular) system Growth Hormone isone of the most abundant. Starting between ages 10-20, the body's Growth Hormone levels begin to decline and AFTER age 30, continue to drop thereafter at a rate of 14% per decade! By age 80, most people barely produce enough GrowthHormone to build a fingernail! Even worse, declining levels of Growth Hormone, which help regulate the body's otherhormones, seem to cause a domino-type collapse throughout the entire hormonal system = result? = AGING.
Can HGH Be IncreasedIn response to this hormonal process, our company has formulated Professional Strength Growth Hormone Formula, anoral spray Growth Hormone supplement straight from nature's laboratory. As we find new ways to make our productsbetter, we act upon that research and create the best product available. We welcome you to the new world of cellularnutrition. This is a world where sound nutrition and life extension are united. Professional Strength Growth HormoneFormula is cellular nutrition good health from the inside out. Healthy cells make for healthy bodies.
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The King of all Growth Hormones. Growth Hormone Potentiatorfor those Over 40. Contains: Somatotropin releasing Peptide Fractions, IGF-1, Peptides, Seguenced Amino Acids, Mucuna extract, Colloidal Mineral Complex. A stimulant that effectively suppresses Somatostationproduction (the hormone released when IGF-1 and GH levels rise that shuts down the pituitary's production of GH); life extension and anti-aging; "Fountain of Youth" reverses biological aging regeneration of all tissues; anabolic; weight loss; increase muscle mass; enhanced libido and sexual performance; younger thicker skin; and hair regrowth.
Growth hormone therapy for the elderly: the fountain of youth proves toxic.
Yarasheski KE, Zachwieja JJ. JAMA 1993.
“rhGH administration in exercising elderly men does not augment muscle fiber hypertrophy or tissue GH-IGF expression and suggests that deficits in the GH-IGF-I axis with aging do not inhibit the skeletal muscle tissue response to training…”
Taaffe DR and coll.J Clin Endocrinol Metab 1996
“..beneficial effects by exogenous DHEA may not be clinically evident…”
Samuel S. C. Yen Proc. Natl. Acad. Sci. USA 2001
Overall health risks exceeded benefits from use of combined estrogenplus progestin for an average 5.2-year follow-up among healthy postmenopausal US women… and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD.
Writing Group for the Women's Health Initiative Investigators. JAMA 2002
Studies completed to date generally suggest that exogenously administered melatonin may serve to extend life span in invertebrates, but evidence supporting this conclusion in mammals is less compelling. Reiter RJ et al, Free Radic Res. 2002
Vitamin D supplementation appears toreduce the risk of falls amongambulatory or institutionalized olderindividuals with stable health by more than 20%.
Bischoff-Ferrari HA et al, JAMA 2004
Hypotension and cognitive impairment: Selective association in patients with heart failure.
Zuccalà G et al. Neurology 2001
Body mass index and mortality among hospitalized patients
< 65 yrs
65-74 yrs
> 75 yrs
Landi F et al, Arch Intern Med 2000
Increases in serum non-high-density lipoprotein cholesterol may be beneficial in some high-functioning older adults: MacArthur studies of successful aging.
Karlamangia AS et al, JAGS 2004
ASSESSMENT CLINICO GERIATRICO
a) Assessment geriatrico
Patologie
Farmaci
Incontinenza
Stato nutrizionale
CaduteOsteoporosi
Sarcopenia
Anemia
Clinica
Funzione cognitiva
Performance fisica
Tono dell’umore
Stato socio-economicoAttività fisica
b) Assessment geriatrico Stato funzionale
Citochine, PCR, estrogeni, androgeni, DHEA, GH, EPO, APP, Genotipo
c) Assessment geriatrico Laboratorio
