File Predicting Survival[1]

Predicting Survival: In 2002, The New England Journal of Medicine reported that peak exercise capacity is THE STRONGEST predictor of death in their landmark study of 6,213 men (Myers, J. et al.). In 2003, The Journal of the American Medical Association reported that low exercise capacity and low heart rate recovery are associated with a 3.5 fold increase in risk of cardiovascular death in women (Wessel, T., et al.). At Maximum Life, we emphasize V02 Max as the primary targeted endpoint in our treatment of both men and women for this very reason. We have found that weight loss, optimization of percentage body fat, blood pressure control, lowering cholesterol, “looking good” and “feeling good” all naturally follow improved peak exercise capacity (i.e., VO2 Max)…living a longer and healthier life is the bonus. There are three primary weapons we employ to maximize our peak exercise capability. Each weapon has battle power utilized alone, but our most successful patients rely on all three. ARM YOURSELF: I. Red Line Workouts II. Low glycemic index, high nutritional value dietary habits III. Evidenced based, medically indicated, hormonal replacement therapy We track important, but often overlooked lab values, like Hemoglobin A1C (HbA1C) because every 1% increase in HbA1C levels results in a 28% increased risk of death regardless of cholesterol, smoking or obesity measures (Brewer, et al., 2008). HbA1C concentration decreases with high intensity resistance training, a “low glycemic-index” nutritional plan, and hormonal optimization (Castaneda, C., et al., 2002, Stevens, T. et al., 2002, Gotherstrom, G., et al., 2007). In fact, studying any survival endpoint (obesity, body mass index, lipid profiles, hypertension, diabetes, smoking, etc…) leads us through a circular reasoning process that ends in the need to improve peak exercise performance via the three pronged synergy of “red-line” exercise, healthy eating, and normalization of hormonal levels (especially thyroid, insulin, estrogen/progesterone, testosterone, and growth hormone). Thyroid, insulin, and even estrogen/progesterone monitoring and treatment is generally accepted as appropriate and beneficial by the medical profession, lay public and media. However, the same “monitoring and treatment” regimen applied to appropriate replacement of testosterone or growth hormone meets resistance primarily due to abuse in athletics. At Maximum Life, we have no interest in treating professional athletes or in abusing these normal substances by elevating them through supplementation to supra-normal levels. On the contrary, we are looking for the benefit of hormonal replacement to optimal levels without the downside that comes with “too much of any good thing”. Testosterone and growth hormone normalization are definitely cardio-protective as they improve exercise capacity and reduce several of the risk factors associated with death (Khaw, K., et al., 2007, Fillippis, E., et al., 2006). In summary, the evidence is overwhelming of the profound benefits obtained from intense brief exercise, hormonal optimization, and a sensible nutritional approach.

References Blackman, M., Sorkin, J., Munzer, T., Bellatoni, M., Whitehead, J., Stevens, T., et al. (2002). Growth hormone and sex steroid administration in healthy age women and men: A randomized controlled trial. Journal of the American Medical Association 288: 2282-2292. Brewer, et al. (2008). A New Zealand linkage study examining the associations between A1C concentration and mortality. Diabetes Care 31: 1144-1149. Castaneda, C., Lay ne, J., Munoz-Orians, L., Gordon, P., Walsmith, J., Forldvari, M., et al. (2002). A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type II diabetes mellitus. Diabetes Care 25: 2335-2341. Colao, A., Cuocolo, A., DiSomma, C., Cerbore, G., Morte, A., Nicolai, E., et al. (1999). Impaired cardiac performance in elderly patients with growth hormone deficiency. Journal of Clinical Endocrinology and Metabolism 84: 3950-3955. Fillippis, E., Lusi, K., Ocampo, G., Bernia, R., Buck, S., Consoli, A., Mandarino, I. (2006). Exercise-induced improvement in vasodilatory function accompanies increased insulin sensitivity in obesity and type II diabetes mellitus. Journal of Clinical Endocrinology and Metabolism 91: 4903-4910. Gonzalez, A., Rota, M., Nurzynska, D., Misao, Y., Tillmanns, J., Ojaimi, C., et al. (2008). Activation of cardiac progenitor cells reverses the failing heart senescent phenotype and prolongs lifespan. Circulation Research, 102: 597-606. Gotherstrom, G., Bengtsson, B., Bosaeus, I., Johannsson, G., Svensson, J. (2007). A 10-year prospective study of the metabolic effects of growth hormone replacement in adults. Journal of Clinical Endocrinology and Metabolism 92: 1442-1445. Hansen,T., Brixon, K., Vahl, N., Jorgeusen, J., Christiansen, J., Mosekilde, L., and Hagen, C. (1996). Effects of 12 months of growth hormone treatment on calciotropic hormones, calcium homeostasis, and bone metabolism in adults with acquired growth hormone deficiency: A double blind, randomized, placebocontrolled study. Journal of Clinical Endocrinology and Metabolism 81: 33523359. Khaw, K., Dowsett, M., Folkerd, E., Bingham, S., Wareham, N., Luban, R., et al. (2007). Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men: European prospective investigation into cancer in Norfolk (Epic-Norfolk) prospective population study. Circulation 116: 26942701.

Myers, J., Prakash, M., Froelichev, V., Do, D., Partington, S., Atwood, J. (2002). Exercise capacity and mortality among men referred for exercise testing. New England Journal of Medicine 346(11): 793-801. Rosano, G., Leonardo, F., Pagnotta, P., Pelliccia, F., Panina, G., Cerquetani, E., et al. (1999). Acute anti-ischemic effect of testosterone in men with coronary artery disease. Circulation, 99: 1660-1670. Rota, M., Padin-Miegas, E., Misao.,V., Angelis, A., Maestroni, S., Ferreira-Martins, J., et al. Local activation or implantation of cardiac progenitor cells rescues scarred infracted myocardium improving cardiac function. Circulation Research, 103: 107-116. Wessel, T., Avant, C., Olson, M., Johnson, D., Reis, S., Sharf, B., et al. (2003). Ability of exercise testing to predict cardiovascular and all causes of death in asymptomatic women—a 20-year follow-up of the lipid research clinic’s prevalence study. Journal of the American Medical Association 290: 1600-1607.