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Remarkable advances
in modern medicine have allowed us to live to unprecedented age:
average human life expectancy has increased from 45 years at the
beginning of the 20th century to greater than 75 years in
the 21st century. However, living longer does not
necessarily mean living better. As we mature and/or suffer
from disease, changes occur in our bodies, causing them to lose the
ability to function as efficiently and effectively as when we were
younger. These changes often result in pain, suffering and
sometimes even premature death.
The aging
population across the world is growing exponentially. As the
"baby-boomer" generation reaches retirement, their needs in terms of
health care, assisted living and caregiver support will place an
immeasurable burden on the world economy. The optimal approach to
this inevitable challenge would be to improve the overall "health"
or vitality of individuals as they age, thereby reducing the
extent and types of care they require in their later years. Even
under the best of circumstances, the development of disease can
compromise quality of life and impose substantial limitations to
vitality. The interactions among the variables which determine
health and disease are complex and make the study of individual
functional capacity particularly problematic. For example, strong
national organizations, such as the American Heart Association,
American Lung Association and the American Cancer Society, focus
attention on specific diseases, even though many of these often
co-exist.
In recent years,
medical researchers have taken two divergent approaches to answering
fundamental questions about medical science and medical practice.
Each trend has generated important new knowledge, but also has
significant limitations in their ability to address this essential
issue of the quality, as well as the quantity of life:
The
Biotechnology Approach: Molecular Biology to Advance Medical Science
Heart disease, lung
disease, cancer, and the neurodegenerative diseases of old age seem
an inevitable part of growing old in western society. The response
of the medical and scientific community has been to take a
reductionist approach: that is, to reduce medical problems to their
smallest component parts -- the underlying genetic abnormalities,
along with the proteins they produce. However, the knowledge of the
parts does not necessarily equate to knowledge of the whole. A good
analogy might be taking apart a car to try to figure out how it
works. After all the pieces are spread out on the floor, you may
realize that even though you know the details of each screw and
wire, you still don't know how all the parts work together to make
the car run; moreover, you may not know how to put all the pieces
back together.
The Epidemiology
Approach: The "Mega Trial" to Define Medical Practice
As counterpoint to the ascendancy of
molecular and cellular biology in medical science, there has been a
growing reliance on large scale clinical trials to establish medical
practice. Epidemiologists ignore individual differences and study
large groups of thousands of patients to determine if a treatment is
beneficial or not often dictating which therapies should be covered
by medical insurance. Although such trends are essential to
fostering safe, affordable, evidence-based medicine, in day-to-day
practice doctors must treat patients as individuals, one-at-a-time.
The "art" of medicine requires physicians to ask: "will my specific
patient benefit from this therapy."
The Institute's
Solution: Putting it all Together With Human Physiology
The Institute for
Exercise and Environmental Medicine strives to fill the void left by
both trends in medicine and science in order to improve the
quality of life for individual patients. Rather than relying on
reductionism, the Institute "puts things together" using the tools
of a branch of science called integrative physiology which
reflects an emphasis on how the complex, individual parts of the
human body are interwoven together to create a functional whole.
The "exercise"
part of the Institute's name derives from the fact that ultimately,
every activity we do, from making a bed to walking around the
office, to playing on the weekend, requires exercise of some form.
The lungs, heart, muscles and nerves all must work in concert to
allow us to accomplish any occupational or recreational activity.
The "environmental" component of the Institute's name
emphasizes that such activities do not take place in a vacuum, but
rather in the context of our external environment, such as the
altitude or temperature, that greatly influences the ability to
function normally.
The Institute is not simply studying how each of the body's organs
work (or don't work), or the makeup of the genes - but are studying
how those things operate as a whole in order to maximize the ability
to enjoy a vital life. The heart, lungs, brain and muscles
must function together for one to be able to live with maximum
vitality. The Institute's research staff study and treat the
whole person, the whole family, and as a result, the whole community.
This integrated approach to human vitality is unique to the
Institute.
Our Mission and Direction
Thus in summary, the mission of the Institute for Exercise and Environmental
Medicine is to explore and define the limits to human functional capacity in
health and disease, with the primary objective of improving the quality of
life for the people in our community. The IEEM pursues this mission by creating an
integrated series of world class laboratories, each with a specific research and
clinical focus that provides experience on a particular aspect of human
physiology and medicine. These include:
I. The Environmental Physiology/Hyperbaric Medicine Unit
II. The Cardiovascular Physiology/Autonomic Function Laboratory
III. The Thermoregulation/Skin Blood Flow Laboratory
IV. The Cardiopulmonary Exercise Laboratory
V. The Swimming Flume/Water Immersion Laboratory
VI. The Biochemistry Laboratory
VII. The Neuromuscular Diseases Center
What Have We Accomplished With This Approach?
In the past 15 years, the faculty working in these laboratories have competed
successfully for $28.4 million in research grants,
published 253 papers in rigorously peer
reviewed scientific journals, written 71 book chapters
in widely circulated medical texts, and presented 349
abstracts at national and international scientific meetings. Moreover, we have
provided service to 5,817 patients, who have received
140,038
treatments/procedures, at our clinical referral programs, which are regional,
national, and even international centers of excellence for a large variety of
clinical problems. We have trained 134 students including the elite of Texas undergraduates from the
Texas Academy of Math and Sciences, doctoral and post-doctoral students and
fellows from more than 10 countries, as well as, resident physicians from our
local hospitals and medical centers.
Discoveries and Advances
The Institute’s
research efforts are applicable to everyday life and improvement of
the quality of life for all persons in the community. The work of
the Institute benefits the population by providing more efficient
and effective ways to treat disease, aging, and the challenges
presented by our extended life span.
Some specific
examples of discoveries and advances generated from the Institute’s
research include:
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The study of the
cardiovascular adaptation to bed rest and spaceflight provides
an important model for the understanding of the clinical problem
of syncope (fainting) from diverse causes. The resources
developed with funding from NASA have allowed the application of
“space age science” on earth to the care of patients with
fainting disorders. As such, the Autonomic Function
Laboratory at the Institute has become an important regional
referral center for patients with orthostatic hypotension and
syncope, providing direct, expert care to patients in North
Texas. |
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The study of the critical contribution of physical
deconditioning to the loss of functional capacity with aging
have shown that 3 weeks of bed rest is equivalent to 30 years of
aging in terms of loss of physical work capacity. Moreover,
research has shown that a 6-month, carefully supervised and
prescribed training program can reverse the functional decline
of 30 years of aging. These observations, which were published
in the scientific literature in the fall of 2001 and widely
cited and discussed in the lay press, have challenged the common
belief that a functional decline with aging is “inevitable.”
New studies, currently funded by the National Institute of
Aging/National Institutes of Health are underway to determine
the exact mechanism of alteration of heart function with aging
(in the absence of cardiovascular diseases) and determine
whether these abnormalities can be reversed with exercise
training. It should be emphasized that the most common cause of
hospitalization and the most expensive use of health care
resources for the population over age 65 is for congestive heart
failure. The Institute’s studies will test the hypothesis that
a significant component of this morbidity is related to
deconditioning, rather than disease, and therefore can be
treated/prevented with exercise training. Therefore, these
studies have the direct impact of improving the health and
quality of life of the aging population in the Dallas community,
and further, may provide a cost-effective treatment for one of
the most common diseases in the western world. |
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The study to identify the specific “dose” of exercise that
provides the optimal improvement in circulatory control helps
reduce the risk of cardiovascular death. One of the most common
questions that a patient will ask a physician is “how much
exercise should I do to optimize my health and minimize my risk
of dying from heart disease?” To date, most studies have been
broad epidemiological studies, which are difficult to apply to
individual patients. However, the Institute’s studies, provide
a physiological rationale for the exact “dose” of exercise
necessary to lower blood pressure and improve cardiovascular
control. Patients in the Dallas community will benefit
directly by having specific guidance on how to tailor their
physical activity and what target goals for exercise training
should be set for both primary and secondary prevention of
cardiovascular disease. |
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The development of a new paradigm in understanding how the human
brain regulates its blood flow has important implications for
stroke prevention, fainting disorders, and possibly even age
related changes in cognitive function. Studies funded by the
American Heart Association are demonstrating an important key
mechanism as to how treatment of both mild and moderate
hypertension improves control of blood flow to the brain.
Patients benefit directly by the establishment of a direct,
pathophysiological link between hypertension and cerebrovascular
disease, and by the identification of a specific target for
therapy. New data in animal models suggest that the earliest,
pre-clinical forms of Alzheimer’s disease may be characterized
primarily by abnormal matching of cerebral blood flow to
metabolic demand. The studies performed in the Institute
will extend these findings to humans and may, therefore, provide
a foundation for a new diagnostic test for early Alzheimer’s
disease, and identify patients who need more aggressive
treatment of hypertension or other therapies delivered at an
earlier point in time. |
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The discovery of new mechanisms for the regulation of blood flow
to the skin has important implications for temperature
regulation and prevention of heat related illness. In North
Texas, heat related injury is a risk of daily life for 1/3 to
1/2 of the year. Moreover, the presence of underlying
cardiovascular disease greatly increases the risk for heat
injury or death from heat illness. Studies funded by the
National Institutes of Health, NASA, and the Doris Duke
Foundation are examining the mechanisms of how humans regulate
skin blood flow and body temperature, and how this process is
impaired in disease states (such as heart failure, or patients
with skin grafts), or by medications. A better understanding
of these mechanisms will allow the development of new approaches
to prevent and treat heat illness, with direct impact for all
North Texans. |
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The study of the description of the changes that occur in the
heart and lungs with normal aging will identify those
characteristics that allow some individuals to remain healthy
and vigorous even into their late 90s. The “holy grail” of
aging research is understanding why some people deteriorate at a
rapid pace, and others remain strong as they age. Certainly
exercise and physical activity play an important role. However,
understanding how different organ systems change with aging, and
how these changes affect functional capacity is essential to
maintaining the functional capacity of our aging population.
Patients in the Dallas community are benefited directly by
helping their doctors differentiate between those abnormalities
caused by medical problems, and those caused by age itself,
allowing the tailoring and optimization of medical therapy. |
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The elaboration of nationally recognized standards for the
quantification of lung function during exercise in aging, lung
disease, and obesity will enable clinical assessment of
respiratory causes of shortness of breath during exertion for
many patient populations. Moreover, the development of a
state-of-the-art laboratory for the assessment of
cardiopulmonary function during exercise has established the
Institute as a regional referral center for patients with
dyspnea (shortness of breath) of unknown etiology. Physicians
in the Dallas area routinely refer patients who are limited by
shortness of breath for assistance in determining the cause and
ultimately the optimal therapy for their problem. |
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The documentation that a specific treatment involving increased
concentrations of oxygen to diabetics with foot wounds may
significantly reduce the requirement for amputation. The
development of a specially designed chamber capable of
simulating high pressure (hyperbaric) or low pressure
(hypobaric) environments has allowed the Institute to deliver
medical care directly to thousands of North Texans. Moreover,
the Institute’s research efforts in this field have placed its
scientists at the forefront of determining which applications of
this expensive therapy are efficacious, optimizing the use of
scarce health care resources. Pilots from the Dallas community
(DFW airport, Simuflite, American Airlines) come regularly for
training in how their bodies react to sudden decompression and
hypoxia improving their ability to fly safely. |
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The discovery that a new non-invasive tool using infra-red light
can be used to determine how muscles use oxygen, and this
information can be used to diagnose disease of muscle metabolism
which lead to unexplained fatigue. |
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The identification of rare diseases of skeletal muscle and the
development of new treatments for such disorders has resulted in
a referral base from all over the world to the Institute’s
Neuromuscular Diseases Center. Patients from the Dallas
community, as well as this worldwide referral base, are helped
directly by the development of new diagnostic strategies, and
new therapies for these specific diseases of muscle metabolism. |
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The invention of a new technique to build red blood cells
involving high altitude training, which has been adopted by
athletes around the world, has resulted in national awards from
the U.S. Olympic Committee and the Wilderness Medical Society,
as well as the recent nomination of the International Olympic
Scientific Prize, the “Nobel Prize” of exercise science.
Athletes from the Dallas area (including Lance Armstrong) are
using this technique to improve their competitiveness. In
addition, recent developments have allowed for the production of
simulated altitude environments at sea level. New studies are
planned extending this unique model to patients with obesity and
type II diabetes, with the goal to use altitude as a way to
reduce appetite. If this high risk/high impact set of studies
bears this hypothesis out, the impact for the Dallas community
and the country at large will be extraordinary. |
How Are We Supported?
Funding for this effort comes from three sources: research grants, clinical
income, and a dedicated endowment. IEEM investigators are supported by grants
from the National Institutes of Health, the American Heart Association, the
American Lung Association, the American Diabetes Association, the Muscular
Dystrophy Association, the Veterans Administration, the United States Department
of Defense, the National Aeronautics and Space Administration (NASA), USA Track
and Field, and the United States Olympic Committee. Such support allows our
faculty to apply "Olympic" and "Space Age" science to the
problems faced by average people everyday. Clinical programs include the
Hyperbaric Medicine Unit, the Neuromuscular Diseases Center, the Autonomic
Function Clinic, and the Cardiopulmonary Exercise Laboratory. Our endowment
includes substantial gifts from the Moss Heart Foundation which has established
the Harry S. Moss Heart Chair in Exercise and Environmental Medicine, the Effie
and Woford Cain Foundation, which has established the Cain Foundation Chair in
Cardiopulmonary Research, the S. Finley Ewing Jr. Chair for Wellness at
Presbyterian Hospital, and numerous individual donors.
How To Sustain This Success?
Our mission is compelling. Medicine is at a crossroads, where helping to
improve or maintain the quality of life -- the ability to function optimally despite
aging or disease -- is as important as prolonging life. Science too is at a
crossroads, where the advances at the basic level must be applied to living
systems to allow the full promise of this exciting technology to flourish. The
Institute for Exercise and Environmental Medicine is at the vanguard of both
roads; yet trends in grant support and medical reimbursement have placed efforts geared towards education and research in jeopardy. Even a brief hiatus
in funding, or change in third party payer profile may lead to the loss of a
valued faculty member or critical research technician. Only sustained support
in the form of a secure endowment can provide the confidence that our research
efforts will continue unabated, and will allow our faculty to concentrate their
efforts on asking and answering the important questions.
To address this problem, we have initiated a capital campaign with a goal of
building the IEEM endowment up to the $16 million range (currently at $5.5
million) within the next three to four years. With such support, the IEEM will
certainly flourish, and continue our efforts at improving the quality of life
for the patients in our community.
Why Should One Support the Institute's Work?
Everyone wants to live better, healthier, fuller lives, but often circumstances
beyond our control prevent us from doing so. Perhaps you or a family member or
friend suffers from heart disease, lung disease, or stroke. Perhaps one of your
children or grandchildren wants to become an astronaut or Olympian. Perhaps your
parents want to remain active in their retirement. Whatever the case, the work
of the IEEM can benefit you and those close to you by providing more efficient
and effective ways to treat disease, optimize our ability to function as we age,
and remain vigorous throughout our lives.
We invite you to play a significant role in improving the quality of life for
your, your family, your friends, and your community. By making a contribution to
the endowment, you play an important role in seeing that the diverse work of the Institute for
Exercise and Environmental Medicine at Presbyterian Hospital will continue
beyond your lifetime.
As James Thomson said, "Health is the vital principle of bliss, and
exercise, of health."
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